P1044 - Sink or Swim: Navigating Flood Syndrome

Victoria Ryherd, DO, Maijd Wess, DO, Clay Williams, MD, Justin Moore, MD, Courtney Hicks, MD, David Martin, PhD, Suporn Sukpraprut-Braaten, PhD
Unity Health-White County Medical Center, Searcy, AR

Introduction: Flood syndrome is the exsanguination of ascitic fluid after the spontaneous rupture of an umbilical hernia. Ascites is the most common complication of cirrhosis, and approximately 20% of patients with ascites will develop an umbilical hernia [^1,2,5]. These hernias develop for two main reasons, increased intra-abdominal pressure and weakening of the abdominal wall muscles ^[1,2,5,6]. Flood syndrome is a rare complication of cirrhosis with ascites and can potentially be fatal with a mortality rate of 30% ^[1-2]. It is important for medical providers to recognize Flood syndrome since complications such as bowel incarceration, infection, and hemodynamic instability can arise ^[1].

Case Description/Methods: The patient is a 54-year-old Caucasian female with a past medical history of alcoholic cirrhosis (Child-Pugh Grade B, Model for End Stage Liver Disease Score = 17) that presented to the Emergency Department for a one-day history of ascitic fluids draining from her umbilical hernia. She stated that she felt a popping sensation and then had a large gush of fluid run down her legs. A colostomy bag was placed over the hernia, and she was started on antibiotics for peritonitis prophylaxis. General surgery took her for an umbilical hernia repair the same day of presentation. The defect was close without mesh and bilateral drains were placed. The patient tolerated surgery well and there were no complications. On postoperative day (POD) six she was deemed stable for discharge from a surgical standpoint and was discharged home.



Discussion: There is no standardized treatment for Flood Syndrome and most literature is case reports or series. Non-surgical treatment or other conservative management is associated with a mortality rate of more than 60% ^[1,2,7,12]. Whereas surgical management has a high postoperative morbidity rate of 71% and mortality rate between 20-60% ^[1,2,7]. If the patient is unable to tolerate surgery, then supportive management with prophylactic antibiotics, diuretics and paracentesis can be used ^[4]. When considering umbilical herniorrhaphy, there are two main surgical techniques, repairing the defect with or without mesh ^[2,8,10]. In suitable patients, umbilical herniorrhaphy without mesh is recommended, followed by ascites control [1,2]. The best treatment for flood syndrome is the prevention of the formation of an umbilical hernia by optimizing ascites management [1-2].




Disclosures:


Victoria Ryherd, DO, Maijd Wess, DO, Clay Williams, MD, Justin Moore, MD, Courtney Hicks, MD, David Martin, PhD, Suporn Sukpraprut-Braaten, PhD. P1044 - Sink or Swim: Navigating Flood Syndrome, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.