1.Multiple Retinal Hemorrhage following Anterior Chamber Paracentesis in Uveitic Glaucoma.
Sang Joon LEE ; Jung Joo LEE ; Shin Dong KIM
Korean Journal of Ophthalmology 2006;20(2):128-130
PURPOSE: We describe the occurrence of a massive retinal hemorrhage following anterior chamber paracentesis in uveitic glaucoma. METHODS: A 33-year-old man who suffered from uveitic glaucoma was transferred to our hospital. The IOP in both his eyes was documented to vary between 11 mmHg and 43 mmHg and remained at a continuously high level for 7 months despite maximally tolerable medical treatment. A paracentesis was performed bilaterally to lower the IOP. RESULTS: Immediately after the paracentesis, massive retinal hemorrhages occurred in the left eye. Multiple round blot retinal hemorrhages with white centers occurred in the equator and peripheral retina, and small slit hemorrhages were observed in the peripapillary area. A fluorescence angiography(FAG) showed no obstruction of retinal vessels but a slightly delayed arteriovenous time in the left eye. CONCLUSIONS: It is important to be aware that patients who have a persistent relatively high IOP are at an increased risk of developing decompression retinopathy due to paracentesis and filtering surgery.
Uveitis, Anterior/*surgery
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Retinal Hemorrhage/*etiology/pathology
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Paracentesis/*adverse effects
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Male
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Intraocular Pressure
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Humans
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Glaucoma/*surgery
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Fundus Oculi
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Follow-Up Studies
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Fluorescein Angiography
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Anterior Chamber/*surgery
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Adult
2.A Case of Lateral Abdominal Wall Hematoma Treated with Transcatheter Arterial Embolization.
Jong Won KANG ; Young Don KIM ; Jong Sam HONG ; Jang Hoon KWON ; Hyun Woong SEO ; Sung Hoon KIM ; Jong Hyuk LEE ; Gab Jin CHEON
The Korean Journal of Gastroenterology 2012;59(2):185-188
Paracentesis is a diagnostic, therapeutic procedure performed in patients with ascites. It is generally thought to be a safe procedure and transfusion of platelet concentrate or fresh frozen plasma is not recommended before the procedure, because the incidence of clinically significant bleeding is very low. We report a case of lateral abdominal wall hematoma due to the injury of the deep circumflex iliac artery after paracentesis in patient with alcoholic liver cirrhosis who was treated with transcatheter arterial embolization.
Abdominal Wall/*blood supply
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Embolization, Therapeutic
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Hematoma/etiology/*therapy
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Humans
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Iliac Artery/injuries
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Liver Cirrhosis, Alcoholic/diagnosis
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Male
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Middle Aged
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Paracentesis/adverse effects
3.A Case of Successful Endoscopic Clipping for Iatrogenic Colon Perforation Induced by Peritoneal Catheter Insertion.
Kyu Yeon HAHN ; Hyun Ju KIM ; Hye Jung PARK ; Sun Wook KIM ; Soo Yun CHANG ; Beom Kyung KIM ; Kwang Hyub HAN ; Sung Pil HONG
The Korean Journal of Gastroenterology 2014;63(6):373-377
Advanced cancer patients with refractory ascites often do not respond to conventional treatments including dietary sodium restriction, diuretics, and repeated large volume paracentesis. In these patients, continuous peritoneal drainage by an indwelling catheter may be an effective option for managing refractory ascites with a relative low complication rate. Peritoneal catheter-induced complications include hypotension, hematoma, leakage, cellulitis, peritonitis, and bowel perforation. Although bowel perforation is a very rare complication, it can become disastrous and necessitates emergency surgical treatment. Herein, we report a case of a 57-year-old male with refractory ascites due to advanced liver cancer who experienced iatrogenic colonic perforation after peritoneal drainage catheter insertion and was treated successfully with endoscopic clipping.
*Catheters, Indwelling
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Colon/*injuries
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Colonoscopy
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Humans
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Intestinal Perforation/*etiology/surgery
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Male
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Medical Errors
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Middle Aged
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Paracentesis/*adverse effects
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Peritoneum
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Rupture
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Surgical Instruments
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Tomography, X-Ray Computed
4.The impact of paracentesis flow rate in patients with liver cirrhosis on the development of paracentesis induced circulatory dysfunction.
Maha Mohammad ELSABAAWY ; Shimaa Rashad ABDELHAMID ; Ayman ALSEBAEY ; Eman ABDELSAMEE ; Manar Abdelaal OBADA ; Tary Abdelhamid SALMAN ; Eman REWISHA
Clinical and Molecular Hepatology 2015;21(4):365-371
BACKGROUND/AIMS: Ascites is a dreadful complication of liver cirrhosis associated with short survival. Large volume paracentesis (LVP) is used to treat tense or refractory ascites. Paracentesis induced circulatory dysfunction (PICD) develops if no plasma expanders are given with ominous complications. To study the effect of ascites flow rate on PICD development. METHODS: Sixty patients with cirrhosis and tense ascites underwent LVP of 8 L were randomized into 3 equal groups of different flow rate extraction; group I (80 mL/minute), group II (180 mL/minute) and group III (270 mL/minute). Plasma renin activity (PRA) was measured baseline and on day six. PICD was defined as increase in PRA >50% of the pretreatment value. RESULTS: In group I through 3; the mean age was (52.5±9.4 vs. 56.4±8.5 vs. 55.8±7.1 years; P>0.05), mean arterial pressure (81.4±5.6 vs. 81.5±7 vs. 79.5±7.2 mmHg; P>0.05), MELD (17.6±4.1 vs. 15.8±4.1 vs. 14.7±4.5). Baseline PRA was comparable (1,366.0±1244.9 vs. 1,151.3±1,444.8 vs. 951.9±1,088 pg/mL; P>0.05). There was no statistically significant (P>0.05) flow mediated changes (Delta) of creatinine (0.23±0.27 vs. 0.38±0.33 vs. 0.26±0.18 mg/dL), MELD (1.25±5.72 vs. 1.70±2.18 vs. 1.45±2.21) or PRA (450.93±614.10 vs. 394.61±954.64 vs. 629.51±1,116.46 pg/mL). PICD was detected in a similar frequency in the three groups (P>0.05). On univariate logistic analysis only female sex was a fairly significant PICD predictor (Wald 3.85, odds ratio 3.14; P=0.05). CONCLUSIONS: The ascites flow rate does not correlate with PICD development.
Adult
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Aged
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Arteries/physiology
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Blood Pressure
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Creatinine/blood
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Enzyme-Linked Immunosorbent Assay
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Female
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Humans
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International Normalized Ratio
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Liver Cirrhosis/*diagnosis/pathology
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Logistic Models
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Male
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Middle Aged
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Paracentesis/*adverse effects
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Renin/blood
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Sex Factors
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Shock/diagnosis/*etiology
5.Transcatheter coil embolization of the inferior epigastric artery in a huge abdominal wall hematoma caused by paracentesis in a patient with liver cirrhosis.
Yun Ji PARK ; Sang Yeon LEE ; Seong Hun KIM ; In Hee KIM ; Sang Wook KIM ; Seung Ok LEE
The Korean Journal of Hepatology 2011;17(3):233-237
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.
Abdominal Wall
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Angiography
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Ascites/surgery
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Embolization, Therapeutic
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Epigastric Arteries/*injuries
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Female
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Hematoma/*etiology/radiography/therapy
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Humans
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Liver Cirrhosis/*diagnosis
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Middle Aged
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Paracentesis/*adverse effects
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Tomography, X-Ray Computed
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Wounds, Nonpenetrating/complications