Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2015; 21(10): 3109-3113
Published online Mar 14, 2015. doi: 10.3748/wjg.v21.i10.3109
Successful surgical management of ruptured umbilical hernias in cirrhotic patients
Nikolaos A Chatzizacharias, J Andrew Bradley, Simon Harper, Andrew Butler, Asif Jah, Emmanuel Huguet, Raaj K Praseedom, Michael Allison, Paul Gibbs
Nikolaos A Chatzizacharias, J Andrew Bradley, Simon Harper, Andrew Butler, Asif Jah, Emmanuel Huguet, Raaj K Praseedom, Michael Allison, Paul Gibbs, Department of HPB and Transplant Surgery, Addenbrooke’s Hospital, Cambridge CB2 0QQ, United Kingdom
J Andrew Bradley, NIHR Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, United Kingdom
Michael Allison, Department of Hepatology, Addenbrooke’s Hospital, Cambridge CB2 0QQ, United Kingdom
Author contributions: All authors contributed in the writing of the manuscript; Chatzizacharias NA also accumulated and analysed the data.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mr. Paul Gibbs, Consultant HPB and Transplant Surgeon, Department of HPB and Transplant Surgery, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom. paul.gibbs@addenbrookes.nhs.uk
Telephone: +44-1223-257074 Fax: +44-1223-216015
Received: August 2, 2014
Peer-review started: August 2, 2014
First decision: August 15, 2014
Revised: September 11, 2014
Accepted: November 18, 2014
Article in press: November 19, 2014
Published online: March 14, 2015
Processing time: 226 Days and 15.2 Hours
Abstract

Acute umbilical hernia rupture in patients with hepatic cirrhosis and ascites is an unusual, but potentially life-threatening complication, with postoperative morbidity about 70% and mortality between 60%-80% after supportive care and 6%-20% after urgent surgical repair. Management options include primary surgical repair with or without concomitant portal venous system decompression for the control of the ascites. We present a retrospective analysis of our centre’s experience over the last 6 years. Our cohort consisted of 11 consecutive patients (median age: 53 years, range: 36-63 years) with advanced hepatic cirrhosis and refractory ascites. Appropriate patient resuscitation and optimisation with intravenous fluids, prophylactic antibiotics and local measures was instituted. One failed attempt for conservative management was followed by a successful primary repair. In all cases, with one exception, a primary repair with non-absorbable Nylon, interrupted sutures, without mesh, was performed. The perioperative complication rate was 25% and the recurrence rate 8.3%. No mortality was recorded. Median length of hospital stay was 14 d (range: 4-31 d). Based on our experience, the management of ruptured umbilical hernias in patients with advanced hepatic cirrhosis and refractory ascites is feasible without the use of transjugular intrahepatic portosystemic shunt routinely in the preoperative period, provided that meticulous patient optimisation is performed.

Keywords: Umbilical hernia; Rupture; Cirrhosis; Ascites; Transjugular intrahepatic portosystemic shunting

Core tip: Acute umbilical hernia rupture in patients with hepatic cirrhosis and ascites is an unusual, but potentially life-threatening complication, with high morbidity and mortality. Management options include surgical repair with or without concomitant portal venous system decompression. Recent data suggested that the routine use of transjugular intrahepatic portosystemic shunt (TIPS) preoperatively in selected patients conferred improved perioperative and longer-term results. We present the successful management of 11 consecutive cases with only minor postoperative complications and no mortality. Based on our experience, the management of such cases is feasible without the use of TIPS routinely in the preoperative period, provided that meticulous patient optimisation is performed.