Percutaneous transabdominal plug-assisted antegrade and retrograde transvenous embolization for the treatment of ruptured paraumbilical varices with concurrent flood syndrome: A case report.

Ruptured paraumbilical varices and Flood syndrome (umbilical hernia rupture with ascites leakage) are both life-threatening conditions, each carrying >30% mortality. Co-occurrence of the 2 requires immediate portal decompression and variceal hemostasis for a chance of survival. This report presents a case of concurrent paraumbilical variceal rupture and Flood syndrome with massive leakage of ascites and blood in a 52-year-old male with alcohol-related cirrhosis. A strategy combining transjugular intrahepatic portosystemic shunt (TIPS) with direct percutaneous transvenous paraumbilical variceal embolization enabled immediate cessation of bleeding and eventual survival. Direct percutaneous transvenous access was the key to rapid hemostatic control, overcoming tortuous anatomy and difficult venous manipulation. This technique expands therapeutic options for complex ectopic varices and supports the safety of direct percutaneous access for portal interventions.