A Rare Case of Spontaneous Umbilical Hernia Rupture- Flood Syndrome

Abstract

A 54-year-old female with alcoholic cirrhosis and massive ascites presented with acute leakage of ascitic fluid from umbilical hernia. Prior to presentation, patient reported progressive increase in abdominal distension due to increasing ascites over several years. She was recently evaluated by a dermatologist for pruritus. Skin examination at that time had revealed excoriated papules, likely due to insect bites or liver disease. 24 hours prior to current presentation, she had been scratching the region of her umbilical hernia, which resulted in a sudden gush of clear fluid. In the emergency department (ED), she denied, fever, chills, cough, vomiting or straining but reported soreness at the site of umbilical hernia. She was tachycardic and appeared icteric. Other vital signs were within normal ranges. Abdominal examination revealed distended abdomen and left lower quadrant tenderness on palpation. A large (10 x 10 cm) umbilical hernia containing bowel was noted which was draining serosanguinous fluid. She was diagnosed with flood syndrome- spontaneous rupture of umbilical hernia. Workup revealed macrocytic anemia with Hemoglobin of 11mg/dl, a platelet count of 100,000 and total bilirubin of 13mg/dl. Broadspectrum antibiotics were initiated and she underwent primary open surgical repair of umbilical hernia with JP drain placement. The drain was eventually removed after 6 days. She was transitioned to oral antibiotics and discharged to a nursing facility. At her 8 month follow-up, she was noted to be doing well with no recurrence.Figure 1Figure 2