Louisiana State University Health Sciences Center Shreveport, LA, United States
Shazia Rashid, MD1, Sam Abdehou, MD2, Mohammad Hassaan Khan, MD1, Aditya Vyas, MD1, Hrishikesh Samant, MD3 1Louisiana State University Health Sciences Center, Shreveport, LA; 2LSUHSC-Shreveport, Shreveport, LA; 3LSU Health Shreveport, Shreveport, LA
Introduction: Decompensated liver cirrhosis manifests in various ways, including variceal bleeding, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome and hepatocellular carcinoma. Flood syndrome, first reported by Frank B Flood in 1961, is the spontaneous leakage of abdominal fluid from an umbilical hernia. It is a rare complication of decompensated liver cirrhosis. We present here a case of a patient who developed flood syndrome as a complication of ascites.
Case Description/Methods: A 55-year-old male with a history of liver cirrhosis, untreated hepatitis C, alcohol abuse, esophageal varices and portal hypertension who presented with a one-month history of fluid leakage from an umbilical hernia. He reported his symptoms started after he noticed an infection around the hernia site. Initially he was managed conservatively with multiple therapeutic paracentesis and leakage spontaneously resolved. He removed the scab off from the hernia site and endorsed persistent leakage of yellow fluid, associated with mild diffuse abdominal tenderness and worsening distension. Abdominal ultrasound and CT abdomen showed cirrhotic liver with a small amount of ascites most pronounced in the hepatic region. CT scan also showed Umbilical hernia with mild fat stranding and vascular congestion in the herniated fat suggestive of inflammatory changes. Paracentesis attempt failed due to poor fluid pockets. His condition improved with diuresis and he was discharged on cefdinir for SBP prophylaxis. He later underwent a successful trans-jugular intrahepatic portosystemic shunt (TIPS) procedure followed by umbilical hernia repair outpatient. He reported doing well on clinic follow up.
Discussion: Flood syndrome is a rare complication of cirrhosis decompensated by ascites and is defined by leakage of fluid from spontaneous rupture of umbilical hernia. It usually precedes skin infection and/or necrosis. Limited data exists on management of flood syndrome. Surgical management with umbilical hernia repair is typically required however, in patients with decompensated liver cirrhosis, extensive pre-operative optimization is required. Hence, this rare condition is often associated with a high mortality rate. Pre-op optimization to reduce portal pressure with TIPS is usually required prior to umbilical hernia repair.
Figure: Protruding umbilical hernia with punctum
Disclosures: Shazia Rashid indicated no relevant financial relationships. Sam Abdehou indicated no relevant financial relationships. Mohammad Hassaan Khan indicated no relevant financial relationships. Aditya Vyas indicated no relevant financial relationships. Hrishikesh Samant indicated no relevant financial relationships.
Shazia Rashid, MD1, Sam Abdehou, MD2, Mohammad Hassaan Khan, MD1, Aditya Vyas, MD1, Hrishikesh Samant, MD3. P2913 - An Unusual Presentation of End-Stage Liver Disease: Flood Syndrome, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
