A185 ABDOMINAL WALL VARICES: A CASE REPORT
Bibliographic record
Abstract
Abstract Background Portal hypertension in cirrhosis results in variable and numerous portosystemic collateral circulations. Computed tomography (CT) and Doppler ultrasound (US) can identify these collateral vessels, especially abdominal wall varices, which can be encountered during a bedside paracentesis. Aims Describe a case of traumatic abdominal wall variceal bleed. Methods Case report. Results A 53 year-old Caucasian male presented to the emergency department (ED) with 4-days of abdominal pain and 2-months of increased abdominal girth. His medical history included Child Pugh Class B alcoholic liver cirrhosis diagnosed 1 year ago. No prior history of ascites, esophageal variceal bleed or hepatic encephalopathy. In the ED, his US showed moderate ascites with right portal vein flow reversal. A diagnostic RLQ paracentesis showed yellow ascitic fluid, no spontaneous bacterial peritonitis (SBP), and he was discharged home with diuretics. He returned to the ED the next day for increased abdominal girth with a Hb of 103 g/L. A diagnostic RLQ paracentesis showed orange-red ascitic fluid and no SBP. The following day, a therapeutic US-guided paracentesis was attempted in the RLQ and left-lower quadrant LLQ; however, ascitic fluid aspirate was grossly bloody. The procedure was aborted. Hb was 82 g/L and progressively decreased. CT angiogram was performed and showed a 10.7 x 4.7 x 8.0 cm hyperdense fluid in the right paracolic gutter near the paracentesis site, consistent with intraperitoneal hemorrhage (Figure A). The insertion site was seen as abdominal wall musculature focal thickening around abdominal wall varices and no contrast extravasation was seen. Gastroesophageal, splenic hilar and omental varices were seen. Doppler US showed no sonographic signs of active extravasation. Interventional Radiology performed a US-guided paracentesis and aspirated 3650 mL of hemorrhagic fluid. Color Doppler US showed small varices within the subcutaneous soft tissues (Figure A). The patient later developed hematemesis with an EGD showing a large high-risk esophageal varix actively bleeding that was banded. Given the refractory variceal bleeding, a Minnesota tube was inserted 4 days later and a transjugular intrahepatic portosystemic shunt was inserted the following day. Unfortunately, the patient developed progressive worsening hepatic encephalopy, multi-organ failure and expired 7-days later. Conclusions Adjunct imaging modalities such as color flow Doppler US or CT can be used as a screening tool to identify abdominal wall varices and reduce paracentesis bleeding complications. Funding Agencies None
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.009 | 0.005 |
| Insufficient payload (model declined to judge) | 0.005 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".