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Doppler ultrasound images at the site of paracentesis before (A) and after (B) periarterial injection of thrombin. (A) Color flow (straight arrow) and arterial waveform (curved arrow) consistent with active arterial bleeding into the peritoneal cavity. (B) Post-thrombin injection images showing cessation of color flow.
Source publication
Paracentesis is a common procedure used in the diagnostic evaluation of peritoneal fluid as well as the therapeutic removal of high-volume ascites. Although generally regarded as a safe procedure, complications may arise from arterial injury, including hematomas and pseudoaneurysms. Transcatheter embolization and surgery are first-line intervention...
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Citations
... However, there is a gap in research regarding the use of PTI for managing stoma-site bleeding, particularly in high-risk patients. Nonetheless, Previous reports have highlighted successful PTI applications in pseudoaneurysms and hemoperitoneum related to paracentesis [11][12][13][14][15][16]. ...
Background
Post-gastrostomy bleeding sequelae are acknowledged, with reported approaches focusing on conservative measures or surgical repair. Nonetheless, Percutaneous Thrombin Injections (PTI) role in PEG-site-related bleeding remains underexplored. PTI under ultrasound guidance is an advocated management strategy for stoma-site bleeding following gastrostomy in high-risk patients, particularly those on direct oral anticoagulants.
Case presentation
This study presents three cases with multiple comorbidities who underwent PTI. Resulting in immediate resolution of bleeding, no systemic\local effect, and no reported complications or rebleeding after a 3–6-month follow-up.
Conclusion
The findings highlight the safety, direct complete resolution, and absence of sequelae associated with PTI, suggesting its potential as a promising technique in managing PEG stoma-related bleeding.
... TIPS and surgical laparotomy can be considered as alternative options. As described in a case report of a man with hemoperitoneum secondary to an injury of the epigastric artery, ultrasound-guided percutaneous periarterial thrombin injection after failure of arterial embolization was successful [44]. ...
... Liver biopsy (LB) is considered a safe procedure too; however, in rare cases, it can be complicated by expanding subcapsular hematoma and liver rupture [44,45]. In a retrospective study with 847 patients receiving a LB, the overall bleeding rate was 0.8% with no patient needing surgical intervention. ...
ABSTRACT
Introduction: Hemoperitoneum can be a life-threating condition in cirrhotic patients who have
a limited compensatory reserve during hemorrhagic shock. We aim to review the literature on the
different etiologies associated with non-traumatic hemoperitoneum (NTH), summarizing the most
relevant conditions associated with spontaneous and iatrogenic peritoneal and retroperitoneal bleeding
that may occur in cirrhotic patients and to illustrate the most relevant diagnostic strategies and
optimal management.
Area covered: This review encompasses the current literature in hemoperitoneum in cirrhotic patients
in the absence of abdominal trauma. Established diagnostic procedures, therapeutic interventions and
potential novel targets are reported and discussed.
Expert opinion: To ensure the optimal management regardless of the underlying etiology of NTH, the
first goal for the clinician is to obtain immediate hemodynamic stabilization with supportive measures
and to control the source of bleeding. The latter can be achieved with angiographic embolization,
which is usually the first choice, or with open surgery. Other therapeutic options according to specific
etiologies include transjugular intrahepatic portosystemic shunt (TIPS), balloon-occluded retrograde
transvenous obliteration (BRTO), balloon-occluded anterograde transvenous obliteration (BATO) or intra
operative radio frequency (RF).
Ultrasound can be used in performing elective percutaneous intervention procedures (e.g. percutaneous biopsy, thermal ablation), but also in the treatment of emergency conditions in intensive care units (placement of the central venous catheter, puncture of the pleural or pericardial effusion, ascites). With the use of ultrasound, real-time puncture visualization is enabled, resulting in increased precision in work with the reduction of complications. For performing percutaneous ultrasound interventions, certain knowledge in the field of ultrasound diagnostics and practical experience in placing a puncture needle or some other material under the control of ultrasound is necessary. It should be noted that ultrasound procedures are safe and effective only if performed by those who have sufficient practical experience.
