Perforation of Vessels and Viscera

In experienced hands, these are uncommon, and in most circumstances they are self-sealing and clinically inconsequential. Rarely, generalized peritonitis and abdominal wall abscess have been reported after the procedure. Most cases of intraperitoneal hemorrhage are due to coagulopathy rather than large-vessel injury.

Prevention:

• Check patient's coagulation status prior to procedure
• Never insert the needle through superficial veins or surgical scars, since scars may have collateral vessels or underlying adherent bowel
• When inserting the needle, avoid continuous suction as this may attract bowel or omentum to the end of the paracentesis needle with resulting occlusion and greater risk of perforation

Management:

• If ascitic fluid appears feculent: withdraw the needle. Observe the patient for 24 hours for signs and symptoms of peritonitis
• If ascitic fluid appears bloody: withdraw the needle and choose another site of entry