The incidence of hemorrhagic complications from large volume paracentesis (LVP) is unknown but hemoperitoneum from rupture of mesenteric varices is associated with a high mortality up to 70%. Signs and symptoms of hemorrhage can manifest from hours up to 1 week after LVP. It has been proposed that a sudden reduction in intraperitoneal pressure from LVP increases the pressure gradient across the walls of mesenteric varices predisposing to rupture. Diagnosis can often be made with a repeat paracentesis but GI bleed and other sources of hypotension in these high risk patients must be ruled out first. Imaging studies are often inconclusive. Treatment for symptomatic patients is transjugular intrahepatic portosystemic shunt (TIPS) with surgical ligation or embolization of the bleeding vessel.
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