{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T20:01:09Z","timestamp":1717790469558},"reference-count":11,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin intervent Radiol"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Paracenteses are considered safe procedures; however, in patients with portal hypertension, the rapid shifts in intraabdominal pressure can prompt hemorrhage from an ectopic varix. Little literature exists on the appropriate management in this clinical setting. Here, we describe a patient with portal hypertension secondary to Budd-Chiari syndrome, presenting with massive hemoperitoneum following paracentesis. Angiography was performed, without revealing an arterial source of bleeding. Subsequently, transjugular intrahepatic portosystemic shunt placement was performed via a recanalized middle hepatic vein, reducing the patient's portosystemic gradient from 15 to 6\u2009mm Hg. This patient developed no further signs or symptoms of bleeding and remained hemodynamically stable until discharge. Follow-up imaging confirmed patency of her shunt and resolution of her ascites, without the need for future paracentesis. This case highlights that in the absence of arterial extravasation, the possibility of ectopic variceal hemorrhage should be considered, which can be successfully treated with portosystemic shunt creation.<\/jats:p>","DOI":"10.1055\/s-0043-1769906","type":"journal-article","created":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T22:37:30Z","timestamp":1689892650000},"page":"274-278","source":"Crossref","is-referenced-by-count":1,"title":["Massive Hemoperitoneum after Paracentesis in a Patient with Budd-Chiari Syndrome: Treated with a TIPS after Negative Arteriogram"],"prefix":"10.1055","volume":"40","author":[{"given":"Dylan J.","family":"Assael","sequence":"additional","affiliation":[{"name":"Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven C.","family":"Sauk","sequence":"additional","affiliation":[{"name":"Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,7,20]]},"reference":[{"key":"ref2","doi-asserted-by":"crossref","first-page":"985141","DOI":"10.1155\/2014\/985141","article-title":"Hemorrhagic complications of paracentesis: a systematic review of the literature","volume":"2014","author":"K Sharzehi","year":"2014","journal-title":"Gastroenterol Res Pract"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s42155-019-0068-y","article-title":"Post paracentesis deep circumflex iliac artery injury identified at angiography, an underreported complication","volume":"2","author":"J Kalantari","year":"2019","journal-title":"CVIR Endovasc"},{"issue":"03","key":"ref4","first-page":"e4167","article-title":"Delayed retroperitoneal hemorrhage as a complication of large-volume paracentesis","volume":"11","author":"P Guzman 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Ansari","year":"2022","journal-title":"Cureus"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1007\/s12072-008-9074-1","article-title":"Updates in the pathogenesis, diagnosis and management of ectopic varices","volume":"2","author":"A Helmy","year":"2008","journal-title":"Hepatol Int"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1155\/1994\/82537","article-title":"Intraperitoneal rupture of ectopic varices\u2013a rare complication of portal hypertension","volume":"7","author":"A N Graham","year":"1994","journal-title":"HPB Surg"},{"issue":"04","key":"ref10","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1016\/j.jhep.2004.06.024","article-title":"Bleeding ectopic varices \u2013 treatment with transjugular intrahepatic porto-systemic shunt (TIPS) and embolisation","volume":"41","author":"M Vangeli","year":"2004","journal-title":"J Hepatol"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1016\/S0016-5085(97)70210-5","article-title":"Acute hemoperitoneum after large-volume paracentesis","volume":"113","author":"C Arnold","year":"1997","journal-title":"Gastroenterology"},{"issue":"08","key":"ref12","first-page":"e3180","article-title":"Precision onion skinning technique for transjugular intrahepatic portosystemic shunt revision","volume":"10","author":"J Matteo","year":"2018","journal-title":"Cureus"}],"container-title":["Seminars in Interventional Radiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1769906.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T22:38:37Z","timestamp":1689892717000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1769906"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6]]},"references-count":11,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2023,7,20]]},"published-print":{"date-parts":[[2023,6]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1769906","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0739-9529","1098-8963"],"issn-type":[{"value":"0739-9529","type":"print"},{"value":"1098-8963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6]]}}}