Case Study: Post Paracentesis Syndrome

Summary

Many people with ascites secondary to liver disease have undergone paracentesis for symptomatic relief, for breathing difficulty due to their greatly increased abdominal girth preventing respiratory movements. A 43-year-old male, a known case of liver cirrhosis with intra-abdominal ascites, underwent paracentesis after confirming an empty bladder, and he returned the next day with bilateral scrotal fluctuant swelling. The swelling was brilliantly transilluminant. There was a definite positive cross-fluctuation sign. The swelling was not tense, nor was it organized to any one particular side. Testes were palpable separately. He was diagnosed to have Post Paracentesis Syndrome.

Background

Liver cirrhosis is a common and frequent problem throughout the world, with varying levels of morbidity affecting the patient. One of the major problems with cirrhosis is the development of refractory ascites, which causes further problems, especially with respiration if the quantity of fluid is great enough. Paracentesis is one of the commonly-used procedures to relieve the pressure on the chest and ease the effort of breathing. However, in rare instances, paracentesis can lead to complications and hamper the good that was meant to be done. Post paracentesis syndrome is one such complication which can occur, causing more distress than relief, even though it is not life threatening in any way.

Case Presentation

A 43-year-old male known to suffer from chronic liver cirrhosis presented to our centre with intra-abdominal ascites of long-standing duration. He was suffering from difficulty in breathing due to his greatly increased abdominal girth causing pressure on the chest wall, thereby leading to respiratory distress, bordering on respiratory acidosis.

Routine investigations were within normal limits with a normal level of haemoglobin and white cell count. His liver function tests revealed raised bilirubin and liver enzymes consistent with cirrhosis of the liver.

It was decided to intervene with the intention of improving his respiratory status. He underwent therapeutic paracentesis after confirming an empty bladder and under strict aseptic precautions. The abdomen was cleaned with Betadine and spirit, and a point located 5 cm above and medial to the anterior superior iliac spine was chosen for the site of puncture. An 18 gauge needle was inserted without local anaesthesia into the peritoneal cavity. A sample of 20 cc was aspirated and sent for microbiological examination. Following this, approximately one litre of fluid was removed from the abdominal cavity.

The patient tolerated the procedure well. He was discharged the same evening and was told to come for a repeat aspiration after 2 weeks, or on recurrence of respiratory distress.

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2 Comments

  1. samir kapadia
    Posted May 2014 at 2:54 pm | Permalink

    Excellent article
    Very well presented

  2. DR Dheeraj V. Mulchandani
    Posted May 2014 at 4:55 am | Permalink

    Thank you!

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