AB146. SOH23ABS_160. Flood syndrome: a rare potentially fatal complication of umbilical hernia: a case report and review of the literature

Background: We report a rare case of Flood syndrome, a potentially fatal complication associated with the spontaneous rupture of an umbilical hernia, and exsanguination of ascitic fluid in a patient with ascites secondary to liver failure.

Methods: A 41-year-old man with decompensated liver disease (Child’s B) secondary to hepatitis C and alcoholic cirrhosis complicated by ascites resistant to diuretics, portal hypertension and oesophageal varices presented with acute rupture of a longstanding umbilical hernia and 6 litres of fluid drainage. Of note the rupture was heralded by the development of ulceration.

Results: Physical exam identified a soft abdomen with non-tender hepatomegaly. The umbilical hernia was erythematous with an ulcer. Otherwise the patient was hemodynamically stable with no encephalopathy. Blood tests were mostly normal with grossly deranged liver function tests (LFTs). The patient was deemed high risk for emergency operation but proceeded first to medical management. The wound was covered with a drainage bag and adequate electrolyte and albumin replacement with broad spectrum antibiotic cover was initiated. The management plan was to allow secondary healing or surgical repair once the liver disease is compensated.

Conclusions: This case highlights a rare complication with high mortality rates (20% to 60%), and stresses the challenge of treatment that falls in the area between medical and surgical management. There is much debate in the literature regarding the surgical management of this rare hernia. Free drainage with local wound treatment, and healing by secondary, along with volume, electrolyte and albumin replacement is important first step with acute surgical intervention rare.

Keywords: Ascites; cirrhosis; flood syndrome; hepatomegally; hernia