Peritoneal Puncture – Procedure, Indications and Risks
Peritoneal puncture is a medical procedure in which fluid is withdrawn from the abdominal cavity. It is used for the diagnosis and treatment of ascites.
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Peritoneal puncture is a medical procedure in which fluid is withdrawn from the abdominal cavity. It is used for the diagnosis and treatment of ascites.
What is a Peritoneal Puncture?
A peritoneal puncture – also known as paracentesis or abdominal tap – is a medical procedure in which a needle or catheter is inserted through the abdominal wall to remove fluid from the peritoneal cavity. The peritoneal cavity is the space between the abdominal organs and the abdominal wall, lined by a thin tissue layer called the peritoneum. Under certain pathological conditions, excess fluid can accumulate in this space, a condition known as ascites.
Indications
Peritoneal puncture is performed for two main purposes:
- Diagnostic paracentesis: A small amount of fluid is removed and analyzed in the laboratory to determine the cause of ascites – for example, in cases of suspected infection, malignancy, or liver cirrhosis.
- Therapeutic paracentesis: Larger volumes of fluid are drained to relieve symptoms such as shortness of breath, abdominal pain, or a feeling of fullness.
Common Causes of Ascites
The accumulation of fluid in the peritoneal cavity can result from various underlying conditions:
- Liver cirrhosis (most common cause, accounting for approximately 75% of all ascites cases)
- Heart failure
- Kidney diseases (e.g., nephrotic syndrome)
- Malignant tumors (e.g., peritoneal carcinomatosis)
- Inflammatory conditions (e.g., tuberculosis, pancreatitis)
- Hypoalbuminemia (low protein levels in the blood)
Procedure
Peritoneal puncture is typically performed under sterile conditions with local anesthesia. The standard steps are as follows:
- Preparation: The patient lies on their back, and the skin is disinfected and covered with sterile drapes. The procedure is often performed under ultrasound guidance to ensure safe needle placement.
- Local anesthesia: The puncture site is numbed with a local anesthetic.
- Puncture: A hollow needle or plastic catheter is introduced through the abdominal wall into the peritoneal cavity. Common insertion sites are the left or right lower abdomen.
- Fluid removal: For diagnostic purposes, 20–50 ml of fluid is collected. For therapeutic purposes, several liters may be drained.
- Completion: The needle is removed, the puncture site is dressed, and the patient is monitored.
Analysis of Peritoneal Fluid
The collected fluid (ascitic fluid) is analyzed in the laboratory for several parameters:
- Cell count and cell types (e.g., elevated leukocyte count indicating infection)
- Protein and albumin content (SAAG – serum-ascites albumin gradient to determine the underlying cause)
- Glucose and lactate dehydrogenase (LDH)
- Cytology (to detect tumor cells)
- Bacterial cultures when spontaneous bacterial peritonitis (SBP) is suspected
Risks and Complications
Peritoneal puncture is considered a safe procedure with a low complication rate. Possible risks include:
- Local bleeding or hematoma at the puncture site
- Infection or peritonitis (inflammation of the abdominal lining)
- Injury to the bowel, bladder, or blood vessels (rare)
- Circulatory dysfunction following large-volume paracentesis
- Persistent leakage at the puncture site
When more than 5 liters of fluid are removed during therapeutic paracentesis, intravenous albumin is typically administered simultaneously to prevent a drop in blood pressure and circulatory complications.
Contraindications
In certain situations, peritoneal puncture should not be performed or should only be carried out with special caution:
- Severe coagulation disorders (coagulopathy)
- Very low platelet count (thrombocytopenia)
- Pregnancy (relative contraindication)
- Skin infection at the planned puncture site
- Severe bowel obstruction (ileus) with significant bowel dilation
Aftercare
Following the procedure, the patient is typically monitored for several hours. Blood pressure, pulse, and the puncture site are regularly checked. Outpatients are advised to rest for the remainder of the day and to seek immediate medical attention if they develop fever, severe pain, or redness at the puncture site.
References
- European Association for the Study of the Liver (EASL). Clinical Practice Guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. Journal of Hepatology, 2010; 53(3): 397–417.
- Runyon, B. A. Management of adult patients with ascites due to cirrhosis: An update. Hepatology, 2009; 49(6): 2087–2107.
- Poca, M. et al. Role of albumin treatment in patients with spontaneous bacterial peritonitis. Clinical Gastroenterology and Hepatology, 2012; 10(3): 309–315.
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