A paracentesis procedure drains excess fluid (ascites) from the abdomen, a common symptom of peritoneal mesothelioma. Doctors can analyze the fluid to diagnose the cause of the buildup, or they may perform a paracentesis to decompress a swollen abdomen and thereby relieve stomach pain and breathing difficulty.
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What Is a Paracentesis?
Paracentesis, also known as an abdominal tap or ascites tap, is a helpful procedure that removes extra fluid from the belly using a hollow needle. This minor surgery provides relief and can improve patients’ comfort.
Inside your abdomen is a lining separating your organs from the abdominal wall. Normally, there is a small amount of fluid between these layers. Fluid in the peritoneal cavity is called ascites or peritoneal effusion if it exceeds an ounce (30 ml). This fluid is known as ascitic fluid.
Quick Facts About Paracentesis
Helps drain excess fluid from the abdominal lining
Usually done as an outpatient procedure
Provides temporary relief from abdominal discomfort
When too much ascitic fluid builds up, it can create pressure on your abdominal organs and diaphragm. This buildup may happen because of various reasons, such as infection, injury, liver issues or cancer. Ascites is often seen in cases of peritoneal mesothelioma.
If the goal is to identify the cause of the ascites, a doctor might take as little as 50 mL of fluid for testing. In therapeutic paracentesis, a doctor may remove a liter of fluid or more to provide relief. A study from 2021 suggested that paracentesis can also enhance the clarity of imaging tests, making it a valuable procedure for diagnosis and treatment.
Can a Paracentesis Diagnose Mesothelioma?
Paracentesis can be a helpful procedure for relieving some of the discomfort peritoneal mesothelioma can cause, but it’s not the best way to diagnose this rare cancer. Sometimes, even when cancer is present, the cells found in the ascitic fluid can appear normal. This is why doctors often need to perform a biopsy, which involves taking a small tissue sample for closer examination instead of relying solely on the fluid analysis.
People with peritoneal mesothelioma often experience ascites or peritoneal effusion. This happens because the cancer can lead to a condition called peritoneal carcinomatosis. In this condition, tumors can damage the lining of the abdomen and block the flow of fluids. Additionally, they can weaken the cells in the abdominal wall, which normally help keep proteins and fats from leaking out of blood vessels into the abdomen.
While ascites is a common sign of peritoneal mesothelioma, it doesn’t always mean the cancer has spread beyond the abdomen. It can result from local tumor damage to the peritoneal lining.
Epifanio Figueroa
Verified Asbestos.com Survivor
Ascites Leads to Peritoneal Mesothelioma Diagnosis
Epifanio says his symptoms began when his stomach started swelling and wouldn’t stop. He went to a doctor who told him fluid was accumulating in his peritoneal cavity. The condition is known as peritoneal effusion or ascites. The peritoneal fluid can collect in the abdomen causing swelling or pain. “So we went to a hospital called Memorial West in Florida and from there they told us they weren’t sure,” Epifanio recounted. “So we went to Cleveland Clinic and they diagnosed me with mesothelioma. That was in 2016.”
Paracentesis is a palliative treatment. This means it helps relieve symptoms, and it can improve quality of life, no matter what stage a patient is in. It’s also an easy procedure that allows you to go home the same day.
If the fluid collects in smaller areas of the abdomen (becomes loculated), a paracentesis may not work. The procedure also doesn’t stop ascites from coming back. Because recurrence of peritoneal effusions after paracentesis is common, doctors often leave a catheter in place for continuous drainage of the fluid, which can be done at home.
There isn’t a set limit on how many paracentesis procedures a patient can have. For some mesothelioma patients, procedures may need to happen every 1 to 2 weeks. Each session that removes a large volume of fluid typically includes an albumin infusion, delivering a human liver protein via IV, to protect blood pressure and circulatory function.
Paracentesis is highly effective at removing abdominal fluid. Studies show a technical success rate greater than 98% for the drainage procedure itself. A review from 2016 found that surgery combined with heated chemo successfully controls ascites in more than 90% of patients.
Expert Insight
A paracentesis is a safe and effective way of removing unwanted fluid buildup in the abdominal area. Your doctor may suggest this procedure to relieve abdominal pressure, and it can often help to understand why it accumulated. It only takes about a half hour and causes minimal discomfort.
Karen Selby, R.N., Patient Advocate at The Mesothelioma Center
Surgical Consultation for Paracentesis
If you believe paracentesis could be a good choice for your mesothelioma, consider meeting with the surgeon and their team to find out more. During this consultation, you will have the chance to meet the surgeon and their skilled team.
They will review your medical history to help determine if this procedure is right for you. This is also a great time for you to ask questions or share any concerns about paracentesis.
The surgical team will provide all the important information you need to prepare for the procedure and recover afterward. These consultations are vital in ensuring that patients are ready for surgery and feel supported throughout the process. You can have your consultation in person or through a video call, whichever works best for you.
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Paracentesis is an outpatient procedure that usually takes about 20 to 30 minutes. Doctors use an ultrasound beforehand to confirm how much fluid has built up and where. You’ll lie on a bed tilted at a 45-degree angle, which helps fluid gather in the lower abdomen, and you’ll empty your bladder before the procedure begins.
Your doctor cleans the insertion site and applies a local anesthetic.
Once the anesthetic takes effect, you’ll likely feel little to no pain during needle insertion. The most common sensation is pressure or a pulling feeling as fluid moves out. Some people have reported having mild cramps when larger volumes drain.
Fluid drains using gravity, a syringe, or a vacuum bottle, typically one liter at a time at no more than 500 mL every 10 minutes to help your body balance fluids and electrolytes.
If a large volume is removed, you may receive a serum albumin infusion to replace what was lost, stabilize blood pressure and reduce the risk of shock.
Once enough fluid is drained, your doctor covers the insertion site with a sterile dressing. If the procedure needs repeating, a catheter with a flow-control valve may be left in place.
You can usually go home within 2 to 4 hours. Most people notice their abdomen feels softer right away, though mild soreness at the insertion site is normal for the first day or two. A small amount of fluid may also seep from the site, so keep it clean and covered with the sterile dressing provided. Rest and avoid strenuous activity for at least 24 hours. Contact your care team if you develop a fever, worsening pain, redness or feel lightheaded. A follow-up visit is usually scheduled to track whether ascites is returning.
Diagram showing how a paracentesis drains ascites or fluid buildup.
Risks and Complications
A paracentesis is a straightforward procedure with very few risks involved. While complications are rare, they can occur. If you have any concerns about the procedure, please talk to your doctor about your specific risks.
Rare Complications of Paracentesis
A persistent leak from the insertion site
Abdominal wall hematoma (a collection of blood outside a blood vessel)
Hypotension (low blood pressure)
Infection
Perforation of the small or large intestine, stomach or bladder
One rare complication noted in a patient with peritoneal mesothelioma was the repeated occurrence of pneumothorax after the procedure. A pneumothorax happens when air builds up in the space around the lungs, which can prevent them from expanding fully. Although this is uncommon, doctors recommend considering it for patients with existing lung issues.
While paracentesis works well for most mesothelioma patients, it’s contraindicated in some cases. For example, people with severe clotting disorders or bowel obstruction may need those issues corrected first. An active skin infection at the insertion site can delay the procedure. Loculated fluid may mean image-guided drainage is needed instead. Your physician will assess if paracentesis is right for you.
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Dr. Landau is the Medical Director of Virtual Hematology at the Medical University of South Carolina, where he leads programs that expand access to cancer care through telehealth. With more than 18 years of experience in oncology and hematology, he specializes in hematologic and genitourinary cancers, including bladder, prostate and kidney cancers. He has held multiple leadership roles in cancer program development and previously served as section chief of hematology and oncology at Orlando Health UF Health Cancer Center, where he founded its telehealth program.
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