SHM Converge Scientific Abstract ePoster Gallery-An Uncommon Complication of Ascites in a Patient With an Umbilical Hernia Flood Syndrome

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Flood syndrome is a rare but serious complication of cirrhosis and ascites in which a large umbilical hernia ruptures, causing spontaneous leakage of ascitic fluid. Though umbilical hernias occur in about 20% of patients with cirrhosis, Flood syndrome is uncommon. It is thought to result from recurrent, high-volume ascites that raises intraabdominal pressure and weakens the abdominal wall until the hernia perforates.<br /><br />The condition can lead to major emergencies, including bowel incarceration, sepsis, and hypotensive shock from rapid fluid loss. Prompt recognition is important, typically by the hospital medicine team, with immediate evaluation and management. CT imaging can help exclude bowel incarceration, and surgical consultation is often needed to assess whether repair is possible. Preventing recurrence focuses on controlling ascites, including consideration of TIPS.<br /><br />The case described involves a 74-year-old woman with MASH cirrhosis and refractory ascites requiring frequent large-volume paracenteses, which had recently increased to weekly. She presented with blood-tinged drainage from a large umbilical hernia. Exam and imaging supported a diagnosis of Flood syndrome, and CT showed fluid-filled herniation without bowel incarceration. She had mild pancytopenia, normal INR, and a low MELD score.<br /><br />Hepatology and transplant surgery evaluated her, but she was not considered a good surgical candidate because of rapidly recurrent ascites and infection risk. She was managed conservatively with pressure dressings, an abdominal binder, volume support, and midodrine for intermittent hypotension after infection and adrenal insufficiency were ruled out. She also underwent additional paracenteses, had a mild upper GI bleed treated with EGD and variceal banding, and ultimately received TIPS. After TIPS, the ascitic drainage resolved, and she was discharged with outpatient follow-up for possible hernia repair.

Asset Subtitle

Claudia A. Sanchez

Meta Tag

Author List Claudia A. Sanchez, Jinal Patel, Jisu Kim

Category Clinical Vignettes

Concept Flood Syndrome

Concept Umbilical Hernia

Concept Cirrhosis

Concept Cirrhotic Ascites

Concept Bowel Incarceration

Distinguished Non-Finalist

Presenter Organization Rush University Medical Center

Presenting Author Claudia A. Sanchez

Track Adult

Keywords

Flood syndrome

cirrhosis

ascites

umbilical hernia

hernia rupture

ascitic fluid leakage

TIPS

paracentesis

hepatology

surgical consultation

Flood Syndrome

Umbilical Hernia

Cirrhosis

Cirrhotic Ascites

Bowel Incarceration