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Umbilical hernias are common in patients with cirrhosis of the liver and ascites. However, spontaneous rupture of the hernia is not frequently seen. This is a serious complication and carries a high mortality. A search of the literature shows that patients have been managed both operatively and nonoperatively for this condition. We present a case of spontaneous rupture of an umbilical hernia in a patient with cirrhosis and ascites which was managed successfully with hernia repair.
THE PATIENT WAS A 58-year-old man with alcoholic cirrhosis and portal hypertension who was admitted onto the medical service with a one-month history of increasing abdominal girth. The patient had had a transjugular intrahepatic portosystemic shunt (TIPS) procedure done about a month before this admission. His past medical history was also significant for diabetes and hypertension. The patient was on medical therapy for control of the ascites and was also on a waiting list for a liver transplant.
On examination he had a massively distended abdomen with a tense but fully reducible umbilical hernia. The skin over the hernia was stretched and there was a one-centimeter ulcerated area. On day five of the admission his umbilical hernia suddenly ruptured as he was trying to get out of bed. The nursing staff reported that a tremendous amount of ascitic fluid drained from his abdomen. On examination his vital signs were stable, and he was alert and mentally well oriented. His abdomen was soft and scaphoid and hepatosplenomegaly was well appreciated. The hernia had ruptured at the site of the ulcerated area.
Fluid resuscitation was initiated with normal saline and fresh-frozen plasma. A Foley catheter was inserted to measure the urinary output and one dose of Cefotetan was administered. After the patient's overall condition was...