Ultrasound-guided paracentesis is commonly performed in the emergency department (ED) setting. Injury to the inferior epigastric artery (IEA) is an uncommon but potentially life-threatening complication of paracentesis. Use of anatomic landmarks has been recommended to avoid this structure. If feasible, sonographic localization of the IEA before ultrasound-guided paracentesis may provide the operator with anatomic mapping of this vascular structure.

We present 5 cases demonstrating the feasibility of identifying the IEA in ED patients with ascites. Why should an emergency physician be aware of this? Sonographic localization of the IEA before ultrasound-guided paracentesis may provide a more reliable means of avoiding iatrogenic injury to this vessel. Further study is warranted to determine whether routine IEA visualization before paracentesis results in a decreased complication rate.