After paracentesis, abdominal wall hematoma occurred in a 49-year-old patient with cirrhosis and ascites. On a computed tomography (CT) scan, a huge hyperdense mass with multiple pseudoaneurysms (arrows), compatible with hematoma, was observed in the right abdominal wall (Fig. 1A and 1B). Right external iliac angiography visualized pseudoaneurysms at the right inferior gastric and lateral circumflex iliac arteries (Fig. 1D), which was confirmed by maximal intensity projection CT images (Fig. 1C). Laboratory findings showed anemia induced by massive bleeding, hemoglobin level (7.4 g/dL) with prothrombin time prolongation. The patient was treated by percutaneous transarterial embolization. Internal mammary artery angiography showed multiple punctate ongoing hemorrhagic foci at the superior epigastric artery (Fig. 2A), which is the terminal branch of the internal mammary artery. The superior epigastric artery was anastomosed with the inferior epigastric artery, which is extremely rare in case of vascular bleeding (Fig. 2B). Branches of the superior gluteal artery showed ongoing large amounts of hemorrhage (Fig. 2C). These vessels were all treated with micro coils and particles, and final angiography showed no ongoing hemorrhagic focus and well embolized arteries (Fig. 2D).

Abdominal paracentesis is a common procedure in patients with liver disease, and thus, the possibility of complications is easily overlooked. To reduce the risk of complications, it is important bleeding tendency be checked before the procedure and that vessels passing through the abdominal wall be avoided by using ultrasound.

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