Incarceration of umbilical hernia following transjugular intrahepatic portosystemic shunt for the treatment of ascites

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) is an effective therapy for patients with medically refractory ascites. Many patients with refractory ascites have umbilical herniation. Incarceration of umbilical hernia has been reported following diuresis, paracentesis, and peritoneovenous shunting. We report 2 cases of umbilical hernia incarceration following resolution of ascites after TIPS.

Editorial: Management of umbilical hernia in patients with advanced liver disease

“…3,4 The best time for umbilical hernia repair has not been considered in the literature; however, control of ascites is believed to be essential to success. 1,5,6 Taking these factors into consideration, an algorithm for the management of umbilical hernias in patients with severe liver disease is suggested (Fig. 1).…”

“…Ultra-low-salt diet, diuretics, abdominal drainage, transjugular intrahepatic portosystemic shunt, and peritoneovenous shunt have each been used. 1,5,6 The high rate of recurrence of umbilical hernias in cirrhotic patients is from the era of suture repair. A trial of prosthetic mesh repair in the general population shows a lower hernia recurrence rate, but a greater wound complication rate, than suture repair.…”

Minimally invasive repair of recurrent strangulated umbilical hernia in cirrhotic patient with refractory ascites

“…Acute removal of the ascitic fluid may precipitate irreducibility of the herniated bowel loop and its incarceration. 9,10 A variety of techniques for open hernia repair in patients with ascites has been described in the literature. [11][12][13] Recently, a laparoscopic approach to hernia repair, with a lower recurrence rate and fewer complications than the open approach, has found favor among surgeons.…”

Hernies et éventrations compliquées du cirrhotique

“…La prévalence de cette complication est estimée à 10 % [3]. L'étranglement est plus fréquent lorsque le collet de la hernie est large et on estime que l'ascite joue un rôle lubrifiant favorisant la mobilité des organes qui franchissent ce collet, ce qui pourrait expliquer le risque d'étranglement en cas de disparition rapide de l'ascite au décours d'une ponction évacuatrice [19]. La rupture de l'ombilic est la seconde complication grave de la HO.…”