SHM Converge Scientific Abstract ePoster Gallery-Ascites With a Chance of Flooding: A Rare Cirrhosis Complication

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<strong>Summary:</strong>

Flood Syndrome is a rare but serious complication of decompensated cirrhosis in which an umbilical hernia ruptures, causing spontaneous leakage of ascitic fluid. This can lead to infection, bowel incarceration or evisceration, cellulitis, peritonitis, sepsis, and hemodynamic instability. Because patients with end-stage liver disease are high risk for surgery, optimal management is not well defined.

This case describes a 46-year-old man with alcohol use disorder and cirrhosis who presented with persistent ascitic fluid drainage from an ulcerated umbilical hernia. He was initially treated with local wound care and skin glue and discharged, but returned a week later with recurrent leakage and erythema around the hernia. During hospitalization, his paracentesis was negative for spontaneous bacterial peritonitis, but he received IV antibiotics for prophylaxis. Attempts at albumin-assisted diuresis failed because of acute kidney injury, so transjugular intrahepatic portosystemic shunt (TIPS) was performed to reduce ascites and improve future surgical candidacy. His course was complicated by an upper GI bleed, and definitive hernia repair was deferred until outpatient optimization.

The authors emphasize that early recognition of Flood Syndrome is critical, especially when an umbilical hernia shows warning signs such as ulceration or necrosis. Management options include supportive measures such as suture repair, fibrin glue, ostomy bag placement, ascites control with TIPS or drainage, and antibiotics for SBP prophylaxis; definitive management is surgical hernia repair when feasible. Although supportive care has high mortality, surgery carries substantial morbidity and risk. Prompt inpatient admission, stabilization, and referral to tertiary care for coordinated surgical and gastroenterology evaluation are recommended.

Asset Subtitle

Jessica S. Fuller

Meta Tag

Author List Caroline Repetti, Heather Frank, Jessica S. Fuller, Margaret Fennell

Category Clinical Vignettes

Concept Flood Syndrome

Concept Decompensated Cirrhosis

Concept Cirrhotic Ascites

Concept Umbilical Hernia

Concept Surgical Repair

Distinguished Non-Finalist

Presenter Organization University of North Carolina - Chapel Hill

Presenting Author Jessica S. Fuller

Track Adult

Keywords

Flood Syndrome

umbilical hernia rupture

decompensated cirrhosis

ascitic fluid leakage

spontaneous bacterial peritonitis

transjugular intrahepatic portosystemic shunt

TIPS

alcohol use disorder

hernia repair

ascites management

Flood Syndrome

Decompensated Cirrhosis

Cirrhotic Ascites

Umbilical Hernia

Surgical Repair