S3292 A Rare Complication of End-Stage Liver Disease: Flood Syndrome

Abstract

Introduction: Flood syndrome describes a condition seen in the setting of end-stage liver disease in which an umbilical hernia ruptures leading to a rush of fluid through the defect. It is a rare complication of cirrhosis and has a high mortality rate. Herein, we present two cases of flood syndrome in patients with advanced liver disease. Case Description/Methods: Case 1: A 37-year-old female with a history of factor Leiden deficiency, MTHFR deficiency, and decompensates alcoholic cirrhosis presented with 1 day of continued fluid leakage from an umbilical wound. She was afebrile, normotensive yet tachycardic to 114 bpm. Abdominal exam showed a positive fluid wave shift and small umbilical hernia with ascitic fluid in the stoma bag. Labs showed a total bilirubin of 11.6 mg/dl, AST of 61 U/L, ALT of 36 U/L, and ALP of 79 U/L. She was treated with antibiotics and underwent hernia repair. She later required large volume paracentesis before the fluid leakage stopped and she was discharged home. Case 2: A 48-year-old female with alcoholic cirrhosis and a history of incisional abdominal hernia secondary to laparotomy presented with abdominal distension, pain and leakage of fluid through the hernia site. Exam showed a midline abdominal protuberance with an ulcerated hernia. CT confirmed the abdominal wall hernia with sigmoid colon in the hernia sac and ascitic fluid and air (Figure 1). She was treated with antibiotics and the defect was closed by general surgery prior to discharge. Discussion: Flood syndrome is a rare complication seen in cirrhotic patients with ascites defined as a rush of fluid through rupture of an umbilical hernia. It is associated with serious complications and a high mortality rate of up to 30%. As such, the most important step in management of ascites is prevention. Sodium and fluid restrictions and diuretics may be used to reduce hypervolemia in these patients. Paracentesis is often necessary to aid in fluid removal in those with recurrent ascites; however, the procedure can also increase the risk of developing flood syndrome. Ultimately, patients may require surgery to repair the defect.Figure 1.: CT demonstrating an abdominal wall hernia with sigmoid colon in the hernia sac and ascitic fluid and air.