Flood Syndrome
The term for an umbilical hernia with rupture leaking ascites fluid is "Flood syndrome." 1
Definition and Clinical Significance
Flood syndrome refers to the spontaneous rupture of an umbilical hernia with leakage of ascitic fluid through the abdominal wall defect. 1 This is a rare but life-threatening complication that occurs almost exclusively in cirrhotic patients with chronic ascites. 2, 3
Key Clinical Features
Presentation: Patients present with visible drainage of ascitic fluid from a ruptured umbilical hernia, often accompanied by diffuse abdominal pain and tenderness. 1
Associated complications: The rupture may occur with or without evisceration of bowel contents through the defect. 4
Mortality risk: This condition carries extremely high mortality rates, with historical reports showing 60-80% mortality with supportive care alone and 6-20% mortality even with urgent surgical repair. 2
Management Approach
Urgent surgical repair is the recommended management for Flood syndrome, as non-operative management confers significantly higher 1-year mortality (67% vs 21% for surgical repair). 5
Initial Stabilization
- Apply sterile occlusive dressings to the rupture site. 3
- Initiate intravenous fluid resuscitation and prophylactic antibiotics. 2, 3
- Optimize the patient's condition before surgery (average 4.2 days in one series). 3
Surgical Timing
- Emergency surgery is mandatory for Flood syndrome despite the presence of refractory ascites. 6
- Delaying repair increases the risk of emergency surgery (92% emergency rate in delayed cases vs 58% in immediate repair). 5
- Undergoing umbilical hernia repair is the most significant protective factor against 1-year mortality (OR = 0.16). 5
Critical Pitfall
- Non-operative management should be avoided, as it leads to continued or increased ascitic leakage, higher rates of emergency surgery, and significantly increased mortality. 5