A rare case of Flood syndrome in emergency department: A case report and review of recent reported cases

Abstract

Introduction: Flood syndrome is a rare and potentially fatal complication of liver cirrhosis with gross ascites. Case presentation: We present a case of Flood syndrome in a gentleman with alcoholic cirrhosis and ascites who had sudden spontaneous rupture of umbilical hernia, resulting in sudden gush of ascitic fluid from the hernia. The wound was cleaned and covered in sterile dressing and was admitted for further management. His umbilical hernia wound was closed at bedside by General Surgery team and he underwent ultrasound-guided ascitic drain insertion by Interventional Radiology. His stay was complicated by bacterial peritonitis which was treated with intravenous antibiotic. Patient eventually recovered and was discharged well. Discussion: Flood syndrome has high complication and mortality rate. Recent reported cases were reviewed, focusing on the causes of cirrhosis, complications of Flood syndrome, treatments provided and the outcomes. Conclusion: There is currently no standard guideline for the management of Flood syndrome which falls in the grey area between medical and surgical management. Proper medical management with early surgical consultation is important to reduce the morbidity and mortality for these patients.

Understanding the Spectrum of Flood Syndrome: A Case Series

“…Literature suggests that supportive management alone had a mortality of 60-80% while the surgical approach had a mortality of just 6-20% [ 7 ]. Most of the current literature shows that emergency surgery with primary closure is the preferable mode of treatment, as a precaution against the development of bacterial peritonitis [ 7 , 8 ]. The risk of bacterial peritonitis is 18% to 23% as estimated by the literature [ 1 , 7 ].…”

Flood Syndrome

“…Flood syndrome refers to the exsanguination of ascitic fluid following the spontaneous rupture of an umbilical hernia. Due to the rarity of this condition, there is no standardized treatment protocol [9], with current literature being limited to case Treatment of Flood syndrome typically begins with fluid resuscitation and antibiotics [6], wound care such as sterile occlusive dressing application [10] or placement of an ostomy pouch [1]. Non-invasive management also includes nutritional optimization, antibiotics, avoiding hepatotoxic medications [8].…”