Transcatheter coil embolization of the inferior epigastric artery in a huge abdominal wall hematoma caused by paracentesis in a patient with liver cirrhosis

Abstract

Therapeutic paracentesis is considered to be a relatively safe procedure and is performed commonly for the control of massive ascites in patients with liver cirrhosis. The commonest puncture site, approximately 4 or 5 cm medial of left anterior superior iliac spine, can be located across the route of the inferior epigastric artery, which is one of the sites of potential massive bleeding. In a 46-year-old woman with liver cirrhosis and refractory ascites, a huge abdominal wall hematoma developed after therapeutic paracentesis. The patient was not stabilized by conservative treatment, and inferior epigastric artery injury was confirmed on angiography. Angiographic coil embolization of the inferior epigastric artery was conducted, after which the bleeding ceased and the hematoma stopped growing. This case indicates that physicians performing paracentesis should be aware of the possibility of inferior epigastric artery injury and consider early angiographic coil embolization when a life-threatening abdominal wall hematoma develops.

A fatal complication of ultrasound‐guided abdominal paracentesis

“…However, its role is still not well defined due to the lack of evidence supporting its efficacy in the medical literature. Despite this, experts suggest that depending on the severity of bleeding, inferior epigastric artery injury can be treated with manual compression, percutaneous thrombin injection via Doppler ultrasound, transcatheter coil embolization, or vessel ligation under open laparotomy . Ferrer et al recommend transcatheter coil embolization for small hematomas and vessel ligation under open laparotomy for large hematomas with massive bleeding …”

“…Despite this, experts suggest that depending on the severity of bleeding, inferior epigastric artery injury can be treated with manual compression, percutaneous thrombin injection via Doppler ultrasound, transcatheter coil embolization, or vessel ligation under open laparotomy. 16 Ferrer et al recommend transcatheter coil embolization for small hematomas and vessel ligation under open laparotomy for large hematomas with massive bleeding. 17 This case suggests that ultrasound-guided paracentesis may need to be more standardized: in particular, abdominal wall arteries and veins need to be identified using duplex/color Doppler imaging before performing any paracentesis.…”

Ultrasound-guided thrombin injection for treatment of superficial traumatic pseudoaneurysms and associated expanding hematomas: experience in five patients

“…Rectus sheath hematomas are anterior abdominal wall bleeds that typically occur as a complication of anticoagulation or traumatic injury to typically the inferior epigastric vasculature. These hemorrhages have the potential to become hemodynamically significant if a substantial amount of blood accumulates in the anterior abdominal wall [ 11 , 12 ]. A similarly related entity is the formation of pseudoaneurysms.…”

“…CT, MRI, and ultrasound permit non-invasive diagnosis, while catheter-based angiography under fluoroscopic guidance allows for simultaneous imaging and treatment of these conditions. In the setting of trauma, angiography provides excellent characterization of pseudoaneurysms as well as a roadmap for treatment through embolization [ 11 , 15 ].…”

Emergency Endovascular Hemostatic Technique Using N-butyl Cyanoacrylate for Retroperitoneal Hematoma Caused by Inferior Epigastric Artery Injury after Undergoing Catheter Ablation for Atrial Fibrillation: A Case Report

“…[4][5][6] As far as we searched in MEDical Literature Analysis and Retrieval System Online (MEDLINE), 19 published reports of 56 iatrogenic IEA injuries treated by EVT were identified between January 1965 and July 2016 ( Table 1). [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] to avoid adherence of the catheter to the glue, and the catheter should be retrieved with aspiration after the injection.…”