Complications
While there are no data on the frequency of sepsis or septic shock in SBP, sepsis in cirrhosis is estimated to occur in at least 30% to 50% of hospital admissions, and patients with cirrhosis are much more likely than other patients to develop a nosocomial infection.[148]
Worsening ascites with subsequent abdominal distention and pain may be the presenting symptom of SBP. Large-volume paracentesis with albumin replacement in the patient without haemodynamic compromise is safe and efficacious in this scenario.[134][135]
Demonstrates how to perform diagnostic and therapeutic abdominal paracentesis.
Bleeding after a paracentesis may occur as an intraperitoneal haemorrhage, an abdominal wall haematoma, or, more rarely, external bleeding.
Reasons for bleeding include injury to the inferior epigastric artery caused by poor selection of puncture site for the paracentesis catheter; puncture of a recanalised umbilical vein or intra-abdominal varices, which may occur more commonly using a midline puncture site; and rupture of mesenteric varices, which is postulated to occur as a result of the sudden reduction in intraperitoneal pressure that can occur during a large-volume paracentesis (this sudden pressure reduction results in an increased pressure gradient across the wall of the mesenteric varices, which may cause a life-threatening haemoperitoneum).[149][150][151] However, studies have found a low rate of bleeding associated with the procedure.[107][152][153][154]
Puncture of the bowel wall with the paracentesis catheter, with subsequent peritonitis or abdominal wall abscess, is a known complication. Ultrasound guidance to help find pockets of fluid that are free from bowel loops may decrease this complication. One study of 242 diagnostic paracenteses reported one case of bowel wall perforation.[155]
Approximately 1% to 5% may develop a persistent leak at the site of the paracentesis.[83][154] This may be prevented in 3 ways: by using a smaller gauge paracentesis needle, by not making the pre-needle incision too wide or too deep, or by using a 'Z-tract' technique of needle insertion. With this technique, the needle is inserted and advanced a short distance. The direction of needle insertion is then changed by about 90° to 120° and advanced another short distance. Finally, the needle direction is changed again to its initial direction. It is hoped that the Z-shaped tract formed by the needle will make it more difficult for ascitic fluids to form a persistent tract. A persistent leak can be treated by applying a purse-string suture while the patient is lying with the affected side up.[156] Applying 2-octyl cyanoacrylate has also been described.[157]
In one study examining 252 episodes of SBP, there were 83 (33%) episodes of abnormal kidney function.[146] Another 2023 study found that in 55.96% of patients with SBP it was associated with abnormal kidney function.[147] This and other studies have demonstrated abnormal kidney function to be the strongest independent predictor of mortality in SBP patients.[144]
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