Abstract
Abdominal paracentesis is a commonly performed diagnostic and therapeutic procedure with a low complication rate. Previously described complications include injury to the abdominal wall, small bowel perforation, and abdominal hemorrhage. Splenic injury has also been described as a complication from bedside procedures including colonoscopy, upper gastrointestinal endoscopy, thoracentesis, and pleural biopsy. This case highlights a previously unreported complication from an abdominal paracentesis, splenic laceration.
Highlights
Diagnostic paracentesis is a commonly performed diagnostic procedure
Given the recent infectious respiratory symptoms and increasing ascites, a diagnostic paracentesis was performed in the emergency department (ED)
Documentation did not specify whether ultrasound guidance was used for the procedure, but revealed a left upper quadrant approach and the removal of 10 cc of bloody fluid
Summary
Diagnostic paracentesis is a commonly performed diagnostic procedure. While complications are rare [1], they have been noted to occur and include injury to intra-abdominal organs and vascular complications [2]. For several weeks prior to hospitalization, the patient had worsening shortness of breath and increasing abdominal swelling, as well as some upper respiratory symptoms. The patient began complaining of left-sided abdominal pain, for which she was given topical anesthetic and admitted to the medicine service for further management. On admission to the medicine service, the patient continued to express concern for significant pain in her upper left abdomen that began after the procedure. The patient’s abdominal exam was significant for exquisite tenderness to light palpation in all quadrants, precluding an assessment of splenomegaly and prompting the concern for a differential diagnosis including spontaneous bacterial peritonitis (SBP) or a complication from the prior paracentesis. The patient received hemodialysis for removal of excess fluid and remained afebrile and with improvement of the abdominal pain.
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