A novel approach to managing ruptured umbilical hernias in cirrhosis.

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.