Case Series of 10 Patients with Cirrhosis Undergoing Emergent Repair of Ruptured Umbilical Hernias: Natural History and Predictors of Outcomes

Malespin, Miguel; Moore, Christopher; Fialho, Andre; Melo, Wanderley José de; Benyashvili, Tamara; Kothari, Anai N.; Sabato, Diego di; Kallwitz, Eric R.; Cotler, Scott J.; Lu, Amy D.

doi:10.6002/ect.2017.0086

Cited by 10 publications

(14 citation statements)

References 13 publications

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“…Finally, it is essential to treat these patients in a tertiary center with specialized surgical and intensive care units due to the increased risk of infection, bleeding, and postoperative decompensation of cirrhosis[ 36 ]. Smaller hospitals cannot provide appropriate care because of their lack of experience[ 7 , 37 ]. In such cases, several alternative methods are described, including the successful placement of a pig-tail drain with no recurrence of ascitic fluid leakage and the injection of fibrin glue into the defect to stem drainage[ 38 - 40 ].…”

Section: Which Is the Best Treatment Approach–conservative Treatment Or Urgent Surgery?mentioning

confidence: 99%

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Management of Flood syndrome: What can we do better?

Strainiene

Peciulyte

Strainys

et al. 2021

WJG

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Approximately 20% of cirrhotic patients with ascites develop umbilical herniation. These patients usually suffer from multisystemic complications of cirrhosis, have a significantly higher risk of infection, and require accurate surveillance– especially in the context of the coronavirus disease 2019 pandemic. The rupture of an umbilical hernia, is an uncommon, life-threatening complication of large-volume ascites and end-stage liver disease resulting in spontaneous paracentesis, also known as Flood syndrome. Flood syndrome remains a challenging condition for clinicians, as recommendations for its management are lacking, and the available evidence for the best treatment approach remains controversial. In this paper, four key questions are addressed regarding the management and prevention of Flood syndrome: (1) Which is the best treatment approach–conservative treatment or urgent surgery? (2) How can we establish the individual risk for herniation and possible hernia rupture in cirrhotic patients? (3) How can we prevent umbilical hernia ruptures? And (4) How can we manage these patients in the conditions created by the coronavirus disease 2019 pandemic?

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Section: Which Is the Best Treatment Approach–conservative Treatment Or Urgent Surgery?mentioning

confidence: 99%

“…This is also known as Flood syndrome, and it was first described by Frank B. Flood in 1961[ 5 , 7 , 8 ]. This is a life-threatening complication with a significant morbidity and mortality rate of 30%.…”

Section: Introductionmentioning

confidence: 99%

Management of Flood syndrome: What can we do better?

Strainiene

Peciulyte

Strainys

et al. 2021

WJG

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“…2,6,9,10 Preoperative medical management should be tailored in conformity to the actual physical state and urgent needs of patients, 22 especially for those with severe encephalopathy or hemodynamic instability; the unstable condition needs to be corrected preoperatively. 6 Malespin et al's 23 recent retrospective study, with small sample sizes of 10 decompensated cirrhotic patients, has demonstrated relatively adverse outcomes after open herniorrhaphy in an emergency setting: 10% mortality and 20% need for urgent liver transplantation.…”

Section: Elective Versus Emergency Surgerymentioning

confidence: 99%

“…In all, 24 of 33 studies [3][4][5][6][7][8][9][10]16,[18][19][20][21][22][23][27][28][29][30][31][32][33][34][35] included cirrhotic patients receiving elective or emergency surgery. Early elective repair of uncomplicated umbilical hernias is recommended in cirrhotic patients with tolerable hepatic functional reserve and good general condition, [3][4][5][6][7]16,[19][20][21] whereas emergency repair is unequivocally indicated by lifethreatening complications, which include rupture, incarceration (not suitable for external reduction), strangulation, and ascites leakage.…”

Section: Elective Versus Emergency Surgerymentioning

confidence: 99%

Umbilical Hernia Repair in Cirrhotic Patients With Ascites: A Systemic Review of Literature

Guo

Liu

Wang

et al. 2020

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Umbilical hernia is a common abdominal complication in cirrhotic patients. The incidence of umbilical hernias can be up to 20% in the presence of ascites. However, there is no consensus regarding the optimal management of umbilical hernias in cirrhotic patients. The purpose of this study is to review the management of umbilical hernias in cirrhotic patients with ascites.Methods: A search of the available literature in English since 1980 was performed using PubMed, the Cochrane Library, and a search of relevant journals and reference lists. The search terms included "umbilical hernia," "ascites," "cirrhosis," and any derivatives of these terms, and the literature search identified all the relevant publications.Results: Thirty-three relevant articles published in the language of English were identified. Fourteen studies involved the management of refractory ascites in cirrhotic patients. Twenty-four studies included cirrhotic patients receiving elective or emergency surgery. Because of much lower morbidity and mortality in elective surgery than in emergency surgery, many authors advocated early elective repair of uncomplicated umbilical hernias in cirrhotic patients. Of these, 2 studies described laparoscopic umbilical hernioplasty, with a significant lower morbidity and hernia recurrence than open repair. Fifteen studies described the use of prosthetic mesh umbilical hernia repair in cirrhotic patients, which was associated with minimal wound-related morbidity and markedly lower recurrences. Conclusions:Our results indicate that early elective repair of uncomplicated umbilical hernias is recommended in cirrhotic patients with tolerable hepatic functional reserve or when the expected time for liver transplantation is > 3 months. Umbilical hernias are supposed to be corrected in the process of liver transplantation, provided that patients could have a better prospect to be transplanted within 3 months. Control of ascites is a crucial part to successful outcomes of umbilical hernia repair. Large volume paracentesis, concomitant peritoneovenous shunting with herniorrhaphy and transjugular intrahepatic portosystemic shunting can be applied to control refractory ascites. Emergency repair of umbilical hernias is indicated in cirrhotic patients with ascites when complications develop.

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“…Approximately 20% of patients with ascites eventually develop umbilical hernias as a result of raised intra-abdominal pressure, weakening of anterior abdominal wall muscles from poor nutrition [1,2], and supraumbilical fascial defect due to possible recanalization of the umbilical vein secondary to portal hypertension [3].…”

Section: Introductionmentioning

confidence: 99%

Flood Syndrome

Lee

Song’En

2022

Gastroenterol Res

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Flood syndrome refers to the exsanguination of ascitic fluid following the spontaneous rupture of an umbilical hernia, and is a rare complication of liver cirrhosis with ascites. In this case report, we describe a 67-year-old patient with Flood syndrome who was initially managed conservatively in a community hospital run by primary care physicians, prior to transfer to a tertiary hospital for specialist surgical review and management. We also performed a literature review of the current treatment modalities to manage this condition.

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Case Series of 10 Patients with Cirrhosis Undergoing Emergent Repair of Ruptured Umbilical Hernias: Natural History and Predictors of Outcomes

Cited by 10 publications

References 13 publications

Management of Flood syndrome: What can we do better?

Management of Flood syndrome: What can we do better?

Umbilical Hernia Repair in Cirrhotic Patients With Ascites: A Systemic Review of Literature

Flood Syndrome

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