A novel approach to managing ruptured umbilical hernias in cirrhosis

Abstract

Background: Ruptured umbilical hernias in patients with ascites (Flood Syndrome) is an uncommon problem with high morbidity and mortality. The treatment of patients experiencing Flood Syndrome is controversial, with a multitude of different treatments being proposed. Method: This paper presents our experience in treating Flood syndrome, and presents a standardized way of treating these patients. Results: Six consecutive patients with Flood syndrome were treated with the same standardized management and surgical technique. All patients had Cirrhosis (Child B and C). All were treated as open emergency operations, with no recurrence or post-operative complications. Conclusion: Though there is a lack of level I or II evidence, the data suggests that ruptured umbilical hernias in cirrhotic patients are a surgical emergency that can be optimally managed with operative management. We present a standardized technique for the repair of these hernias which is simple, reliable and appears to have reproducible results. The technique aims to provide a hermetic seal immediately peri-operatively and is supported by medical optimization of the post-operative period. Our small case series represents effective and safe management in appropriately selected patients.

Understanding the Spectrum of Flood Syndrome: A Case Series

“…The risk of bacterial peritonitis is 18% to 23% as estimated by the literature [ 1 , 7 ]. Novel techniques such as using fibrin glue have been described with good efficacy but inadequate data on recurrence [ 9 ]. Recent research has also evaluated the use of transjugular intrahepatic portosystemic shunts (TIPS) without surgery in the management of Flood syndrome to some avail [ 10 ].…”