Management of Flood syndrome: What can we do better?

Abstract

Approximately 20% of cirrhotic patients with ascites develop umbilical herniation. These patients usually suffer from multisystemic complications of cirrhosis, have a significantly higher risk of infection, and require accurate surveillance– especially in the context of the coronavirus disease 2019 pandemic. The rupture of an umbilical hernia, is an uncommon, life-threatening complication of large-volume ascites and end-stage liver disease resulting in spontaneous paracentesis, also known as Flood syndrome. Flood syndrome remains a challenging condition for clinicians, as recommendations for its management are lacking, and the available evidence for the best treatment approach remains controversial. In this paper, four key questions are addressed regarding the management and prevention of Flood syndrome: (1) Which is the best treatment approach–conservative treatment or urgent surgery? (2) How can we establish the individual risk for herniation and possible hernia rupture in cirrhotic patients? (3) How can we prevent umbilical hernia ruptures? And (4) How can we manage these patients in the conditions created by the coronavirus disease 2019 pandemic?

Keywords: Umbilical hernia rupture; Ascites; Cirrhosis; Flood syndrome; COVID-19; Literature review

Core Tip: Flood syndrome is a rare, life-threatening complication of large-volume ascites and end-stage liver disease resulting in a sudden umbilical hernia rupture and spontaneous paracentesis. It remains a challenge for clinicians, as recommendations for the management of this syndrome are lacking. The establishment of the individual risk for herniation and possible hernia rupture, timely prevention, and elective surgical treatment might reduce the risk of complications and the need for urgent surgery.