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All Journal The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Audi Yanto, Theo
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Medicine & Pharmacology

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A Case Report of Untreatable Complication of Umbilical Hernia in Cirrhosis: A Flood Syndrome Tan, Christine; Audi Yanto, Theo
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 26, No 2 (2025): VOLUME 26, NUMBER 2, AGUSTUS, 2025
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2622025188-194

Abstract

Flood syndrome is a rare, life-threatening complication of end-stage liver disease, characterized by the spontaneous rupture of an umbilical hernia. It frequently presents with sepsis, peritonitis, and bowel incarceration, carrying a high mortality rate. The lack of standardized treatment guidelines and the complexities of advanced liver disease make management particularly challenging. We report a case of a 53-year-old woman with decompensated hepatitis B-related cirrhosis (Child-Pugh Class C, MELD score of 26) and refractory ascites, who developed Flood syndrome. She presented with a ruptured umbilical hernia leaking ascitic fluid, accompanied by sepsis, diabetic ketoacidosis, acute kidney injury, and hypoalbuminemia. Surgical intervention was deemed high-risk, and conservative management was undertaken, focusing on infection control, wound care, and medical stabilization of her comorbidities. Despite a multidisciplinary approach, the patient succumbed to the cumulative effects of her advanced disease and associated complications. This case highlights the complexities of managing Flood syndrome, particularly in patients with advanced liver disease. The absence of standardized treatment protocols necessitates a multidisciplinary, individualized approach. Key considerations include managing ascites, preventing infection, optimizing glycaemic control, and carefully evaluating the risks of surgical intervention. This case report illustrates the clinical course, management challenges, and outcomes of Flood syndrome in a patient with advanced cirrhosis, in order to highlight key considerations for clinicians and underscore the urgent need for further research to establish evidence-based guidelines for managing this rare but life-threatening condition.
Co-Authors Tan, Christine