Umbilical hernia in a patient with ascites. Clinical case

Abstract

INTRODUCTION. Since 1808, umbilical hernias were registered based on existing data, in such a way that 4716 scientific articles were registered in the last two centuries. About 6 to 14% of all abdominal wall hernias in adults are umbilical hernias with a prevalence of 2%. CLINICAL CASE. A 47-year-old male came to the emergency room presenting with a giant umbilical hernia, liver cirrhosis and increased abdominal girth, fluid retention (ascites) to perform paracentesis of approximately 5 Liters, presenting confusion, asterixis, dyslalia, aphasia, upon admission. no coordination of walking. On physical examination, she was found to be hemodynamically unstable with the presence of ascitic fluid leakage through an ulcer caused by tension in the umbilical region; feverish peaks, for which reason a liquid sample was taken by puncture in the left iliac fossa, yellow in color and cloudy in appearance with glucose 106 mg/dL, LDH 239 mg/ml, presence of Hb (+++), and leukocytosis. He was evaluated for general surgery. Where a non-reducible incarcerated umbilical hernia was observed, it was decided to treat the complicated hernia, partial omentectomy plus ventral plasty with the Rives-Stoppa technique plus omphaloplasty with Drenovac-type closed drainage was performed without complications. DISCUSSION. Cirrhotic patients who do not respond to medical treatments for ascites will require treatment such as serial therapeutic paracentesis. Large volume paracentesis (LVP), defined as the removal of more than 5 L of ascitic fluid, is an effective therapy for patients with tense ascites.