Flood syndrome managed by partial splenic embolization and percutaneous peritoneal drainage

Abstract

Flood syndrome is a rare complication of cirrhosis of liver accompanied by ascites and a sudden rupture of umbilical hernia causing drainage of ascitic fluid from abdominal cavity. We report management of a case of Flood syndrome which was caused by rupture of incisional hernia. The clinical picture was similar to well described and widely accepted Flood syndrome. A 70-year-old female with decompensated hepatitis C cirrhosis was transported to the emergency department with a sudden drainage of ascitic fluid after sudden dehiscence of pre-existing incisional hernia and diffuse abdominal tenderness. Initially, she was managed by applying ostomy bag and diuretics to reduce the ascites. On 8th day of admission, a 16 Fr. drain was percutaneously placed in the left lower abdominal quadrant to divert the fluid from the abdominal wall defect. On 13th day, 80% partial splenic embolization (PSE) was attempted to control portal hypertension to reduce the ascites volume. After PSE, the hepatic venous pressure gradient reduced from 28 to 21cm H 2 O. The peritoneal drain was removed on 16th day and she was discharged on 22nd day. We conclude that PSE and temporary percutaneous peritoneal drainage are useful option to manage Flood syndrome.

Stepwise partial splenic embolization for portal hypertension based on a new concept: Splanchnic caput Medusae

“…In liver cirrhosis, spleen/liver volume ratio increases [7] . PSE not only increases platelet count, but also reduces the splenic venous blood flow volume, portal venous pressure, and spleen/liver volume ratio [5 , 6] . Surgical techniques such as Sugiura procedure [20] and Hassab's operation [21] are some of the accepted surgical treatments with splenectomy.…”

“…We have reported that partial splenic embolization (PSE) not only increases platelet count, but also reduces the splenic venous blood flow volume, portal venous pressure and spleen/liver volume ratio [5] , [6] , [7] . Management of splenomegaly with thrombocytopenia is important in the treatment of portal hypertension [8 , 9] .…”

Verification of thrombus formation just after endoscopic injection sclerotherapy with ligation for esophagogastric varices by venous phase of left gastric arteriography

“…Rebleeding can be prevented by setting the HVPG to 12 mmHg or less [1 , 2] . PSE not only increases platelet count but also reduces the portal venous pressure, splenic venous blood flow volume and spleen/liver volume ratio [4] , [5] , [6] . We have reported the advantages of the hybrid procedure combining endoscopic treatment and PSE for esophagogastric varices [8] .…”

“…In the new concept, partial splenic artery embolization (PSE) is considered the treatment of Medusae's face. We have reported that PSE not only increases platelet count but also reduces the splenic venous blood flow volume, portal venous pressure, and spleen/liver volume ratio [4] , [5] , [6] . Endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) are considered the treatment of Medusae's hair.…”

A novel approach to managing ruptured umbilical hernias in cirrhosis

“…2,4,5 The treatment of patients experiencing Flood Syndrome is controversial, with a multitude of different treatments, both operative and non-operative being proposed. [5][6][7][8] This paper presents our experience in treating Flood syndrome, and presents a standardized way of treating these patients.…”