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J Korean Soc Emerg Med > Volume 30(2); 2019 > Article
Journal of The Korean Society of Emergency Medicine 2019;30(2): 166-175.
간경변 환자에서 다량의 복수가 하복벽동맥의 위치를 변화시키는가?
김두솔 , 김재승 , 이정훈 , 이승철 , 서준석 , 도한호 , 이상헌
동국대학교 일산병원 응급의학과
Does the large amount of ascites lateralize the inferior epigastric artery in liver cirrhosis?
Doosol Kim , Jae Seong Kim , Jeong Hun Lee , Seung Chul Lee , Jun Seok Seo , Han Ho Doh , Sanghun Lee
Department of Emergency Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
Correspondence  Jae Seong Kim ,Tel: 031-961-7761, Fax: 031-961-7775, Email: tidejee@gmail.com,
Received: August 17, 2018; Revised: October 5, 2018   Accepted: October 22, 2018.  Published online: April 30, 2019.
ABSTRACT
Objective:
The most common cause of hemorrhage after paracentesis is direct needle puncture of the inferior epigastric artery (IEA). This study examined the relationship between the amount of the ascites and the location of the IEA in liver cirrhosis.
Method:
Abdominal computed tomography (CT) examinations of patients with liver cirrhosis were reviewed retrospectively and divided into two groups according to the amount of ascites. The distances between the midline and the IEAs of both sides were measured at the umbilicus, McBurney’s point, anterior superior iliac spine, and mid-inguinal level. Branching of the IEAs, abdominal wall and mesenteric varices in the abdomen below the umbilicus level were recorded.
Results:
A total of 120 abdominal CTs were reviewed. The distances from the midline to the IEA in the large ascites group were longer than those in the small ascites group at the level of the right McBurney’s point (44.5±14.6 mm vs. 39.6±11.8 mm, P=0.043) and left McBurney’s point (48.6±15.3 mm vs. 43.3±11.5 mm, P=0.035). The incidence of abdominal wall varices was higher in the large ascites group (21.7% vs. 5.0%, P=0.014).
Conclusion:
In patients with liver cirrhosis, the large amount of ascites might be associated with lateralizing the location of the IEA. Moreover, it may be necessary to confirm the blood vessels in the abdominal wall and mesentery near the puncture site by bedside ultrasound before the paracentesis.
Key words: Epigastric arteries; Paracentesis; Liver cirrhosis; Hemoperitoneum
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