Spontaneous evisceration of bowel through an umbilical hernia in a patient with refractory ascites
A 50-year-old Caucasian male with a long-standing history of cirrhosis, secondary to chronic alcohol abuse and hepatitis C infection, presented to the Emergency Department with evisceration of his small bowel through an existing umbilical hernia (Fig. ). The patient had a complicated course of liver disease marked by recurrent ascites and hepatic encephalopathy. Two years prior, the patient had his umbilical hernia primarily repaired; however, he developed a recurrence of the umbilical hernia secondary to recurrent and refractory ascites. The patient stated that he suddenly noticed protrusion of bowel through his umbilical skin after a sudden coughing bout several hours prior to presentation. The patient also reported copious drainage of ascitic fluid through the hernia site following the evisceration. He presented to the emergency room dehydrated and with signs of peritonitis. The patient was promptly resuscitated and taken to the operating room. He underwent segmental small bowel resection and biologic mesh repair of the umbilical hernia. Following his surgery, the patient spent 7 days in the ICU after which he was transferred to a medical–surgical floor and subsequently discharged with normal bowel function and in stable condition. He has remained recurrence free several months after.