V-034 SPONTANEOUS EVISCERATION THROUGH AN UMBILICAL HERNIA

Abstract

Abstract Aim Umbilical hernia in the cirrhotic patient is frequently seen in the setting of refractory ascites. Nevertheless, spontaneous evisceration is an unusual and potentially life-threating event. This hernia rupture has a high mortality and morbidity and presents many challenges in medical and surgical management. Material & Methods We present a case of a 58 years-old man with personal history of alcoholic cirrhosis with multiple ascites drainages, portal hypertension and hepatic encephalopathy. The patient went to the emergency department suffering from an umbilical hernia with spontaneous rupture and evisceration. Results An urgent umbilical hernioplasty was conducted. We performed a hernia sac and suprafascial dissection. We verified that the vascularization of the hernia content was correct. We close peritoneum with double suture (transfixion ligature and continuous suture techniques) and fascia defect. We finally placed an onlay mesh. In the postoperative period, the patient had no complications related to dehiscence of suture or peritoneal fluid leakage, but stayed hospitalized for 25 days due to the decompensation of the cirrhosis. After six months of follow-up, there are no signs of recurrence. Conclusions Cirrhotic patients undergoing abdominal surgery are prone to complications, especially in hernias with spontaneous evisceration. One of de most frightening surgical complications in cirrhotic patients is the leakage of peritoneal fluid. In our case, this leakage could not have been produced because we used double suture and transfixion ligation to close peritoneum.