Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
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Case Report

Volume 15, Number 4, August 2022, pages 217-224

Flood Syndrome


Figure 1.
Figure 1. Ulcerated umbilical hernia.
Figure 2.
Figure 2. Ascitic fluid leaking from a ruptured umbilical hernia, being held up by staff wearing blue gloves.
Figure 3.
Figure 3. Urostomy bag utilized to monitor ascitic fluid output from Flood syndrome.
Figure 4.
Figure 4. CT scan of abdomen revealing an umbilical hernia with a small abdominal-cutaneous tract forming (red arrow). CT: computed tomography.
Figure 5.
Figure 5. Healed umbilical hernia wound (11 months after hospital discharge).


Table 1. Summary of Management of Cases of Flood Syndrome Published in the Literature
TechniqueDescriptionStudy designOutcomesReference
POD: postoperative day; PVS: peritoneovenous shunting; TIPS: transjugular intrahepatic portosystemic shunting.
Medical management
  ConservativeSalt restriction, diuretics, sterile dressings, antibioticsCase reportDeath: 2 months after from rupture of esophageal varices.[25]
Ostomy pouch, diuretics and antibioticsCase reportSurvived with complications: recurrent admissions, spontaneous bacterial peritonitis, hyponatremia, and renal injury.[1]
Pressure dressings, diuretics and antibioticsCase series: two cases, with one case managed conservativelySurvived with good outcome: underwent PVS due to refractory ascites, 2 years’ follow-up with no recurrence of ascitic leak.[20]
  Fibrin glueFive milliliters fibrin glue into the fascial defect and diureticsCase reportSurvived with good outcome: no recurrence in 12 months’ follow-up.[26]
Five milliliters fibrin glue into the base of the ulcerated leaking of the hernia after ascitic drainageCase reportSurvived with good outcome: no recurrence in 4 months’ follow-up.[27]
Surgical management
  Percutaneous abdominal drain for secondary intention closure of the defectPigtail drainCase reportSurvived with good outcome.[4]
Pigtail drainCase reportSurvived with complications: discharged with drain however defaulted follow-up and represented in 6 weeks with peritonitis.[9]
  Partial splenic embolization and temporary percutaneous peritoneal drainage16 Fr. Drain inserted in the left lower abdominal quadrant. Partial splenic embolization using gelatin sponge and microcoils.Case reportSurvived with good outcome.[24]
  PVSClosure of fascial defect and PVS, either simultaneous or sequential.Case series: four patients had spontaneous umbilical hernia rupture.Survived with good outcome: three patients at 3 - 19 months’ follow-up. Death: one patient died 2 years later from gastrointestinal bleed.[23]
Peritoneovenous shunting under local anesthesia.Case series: one patient underwent hernia repair.Survived with good outcome: at 2 years’ follow-up.[20]
  TIPSTIPS without hernia repair.Case reportSurvived with complications: acute kidney injury and septic shock secondary to cholecystitis, subsequently recovered.[7]
TIPS before surgical umbilical hernia repair.Case reportSurvived with good outcome.[5]
Retrospective chart review: four patients had TIPS before hernia repair.Survived with good outcome: two patients. Survived with complications: one patient had worsening encephalopathy; one underwent liver transplant for liver decompensation.[3]
Case seriesSurvived with good outcome: no recurrence at 5 - 13 months’ follow-up.[22]
Case series: two patientsSurvived with good outcome.[2]
Retrospective chart review: four patients.Survived with good outcome: two patients. Survived with complications: one patient had worsening encephalopathy requiring supportive care; one patient had liver decompensation requiring liver transplant.[3]
  Umbilical hernia repair/closurePrimary repair without mesh, excision of excessive necrotic skin.Case series: eight patientsDeath: one patient. Survived with complications: two patients had liver decompensation requiring liver transplant. Survived with good outcome: five patients.[2]
In all cases, with one exception, a primary repair with non-absorbable Nylon, interrupted sutures, without mesh.Case seriesSurvived with complications: nine patients (wound infection, antibiotics allergy, ileus, and liver transplant). Survived with good outcome: one patient at 54 months’ follow-up.[17]
One patient had elective repair with onlay polypropylene mesh.Survived with good outcome at 9 months’ follow-up.
Primary open surgical repair of umbilical hernia with JP drain placement.Case reportSurvived with good outcome at 8 months’ follow-up.[18]
Umbilical herniorrhaphy without mesh and drain insertion.Case reportSurvived with complications: acute kidney injury, spontaneous pneumothorax, failure to thrive - discharged to hospice care.[15]
Closure of umbilical defect.Case reportSurvived with good outcome: discharged 2 days later with oral antibiotics.[11]
Emergent repair no drain insertion.Retrospective chart review: two patientsSurvived with complications: one patient had ascitic leak underwent TIPS on POD 5, one had liver decompensation requiring liver transplant.[3]
Debridement of necrotic skin overlying the hernia, running closure of the fascia with continuous non-absorbable suture (2-0 polypropylene), and primary closure of the skin.Case seriesDeath: one patient (colonic dilatation and liver failure). Survived with complications: one patient (wound infection which healed). Survived with good outcome: seven patients.[13]
Resection of infarcted omentum and primary closure of hernia defect with interrupted 1-0 nylon sutures.Case reportSurvived with complications: aspiration pneumonia, decompensated liver disease, feed intolerance, spontaneous bacterial peritonitis - discharged after 32 days of hospitalization with no hernia recurrence.[8]
Excision of ulcerated umbilical skin, hernial sac and ring, and primary closure of incision.Case reportSurvived with complications: alcohol withdrawal syndrome, discharged on day 7 of admission.[14]
Excision of necrotic skin and hernia sac, closure of umbilical defect with polydioxanone sutures, insertion of abdominal drain.Case seriesSurvived with complications: recurrent hernia defect with incarcerated bowel; underwent resection of strangulated omentum and closure of hernia defect with onlay monofilament polypropylene mesh, prosthetic mesh infection and bacterial peritonitis; readmission 1 year later with refractory ascites and encephalopathy.[16]
Excision of hernia sac and closure of peritoneum with polydioxanone sutures and hernial defect with 6 × 6 cm soft polypropylene sublay mesh.Survived with good outcome.
Primary closure with drain insertion.Case reportSurvived with good outcome.[12]
Biomesh hernia repair.Case reportSurvived with good outcome.[19]
Bedside closure of umbilical hernia ulcer and ascitic drain insertion.Case reportSurvived with complications: bacterial peritonitis treated with antibiotics - improvement in condition and discharged after 6 days.[10]
Closure of skin over umbilical hernia under local anesthesia with simple running nonabsorbable monofilament suture, defect in the skin overlying the recurrent umbilical hernia was oversewn.Case series: one case underwent PVS.Death: readmitted with umbilical hernia rupture 2 months later with acute renal failure and death.[20]
Exploratory laparotomy and umbilical wall defect repair.Case reportNot mentioned.[6]
Resection of strangulated omentum and repair of abdominal wall defect.Case reportNot mentioned.[21]