New onset dysrhythmia induced by post-operative gastric bypass hypokalemia

Paracentesis is commonly performed in the emergency department. Anatomical landmarks helps to identify the site of needle placement to initiate the procedure. However, in inexperienced hands, landmarks-based needle puncture may lead to failure like dry-tap or complications like bleeding inside abdomen, bowel puncture, etc. Henceforth, the use of ultrasonography to identify the safe site of needle placement is being incorporated in routine practice in ED. Emergency physicians being well versed with Point-of-care USG, safe site identification for paracentesis does not need any special learning. Tubercular ascites due to chronic inflammatory conditions stay for a longer duration and give rise to septae. Multiple septae through crosslinking produce loculated collections. Incidently, while USG screening for safe site before needle insertion for paracentesis one such patient, a typical spider web appearance was observed, which is reported here.