Singh Karamveer, Lokavarapu Manoj Joshua, S Kumar Nayana, Gupta Amit, V Arunkumar, Singh Dipendra, Singh Vatsala, Raja Mohammad Shahid, Ammapalem Satish, Selvarasu Monisha
General Surgery and Division of Organ Transplant, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
Cureus. 2025 Apr 19;17(4):e82578. doi: 10.7759/cureus.82578. eCollection 2025 Apr.
Background Complicated umbilical hernia in decompensated chronic liver disease is a significant cause of morbidity and mortality. This study evaluates the management strategies and factors predicting outcomes following emergency umbilical hernia repair. Methods A retrospective analysis was conducted on six patients with decompensated chronic liver disease who presented with complicated umbilical hernia in an emergency setting to the hepatopancreatobiliary (HPB) surgical unit between July and December 2024. Preoperative characteristics, intraoperative findings, and postoperative outcomes were reviewed. Results A total of six patients were included. The mean age was 51.16 years (range: 44-58), and all presented with abdominal pain (6, 100%). Among them, two (33.3%) presented with a strangulated umbilical hernia, two (33.3%) with an obstructed hernia, and two (33.3%) with a ruptured hernia associated with ascites fluid leak. All patients (6, 100%), underwent emergency surgery. Bowel resection was required in three (50.0%) patients, of whom two (33.3%) underwent primary anastomosis and one (16.7%) underwent a double-barrelled ileostomy. All six (100%) patients underwent primary repair of the hernial defect without mesh placement. Postoperative recovery was uneventful in four (66.7%) patients; one (16.7%) patient developed an ascites fluid leak, and one (16.7%) died. The mean postoperative hospital stay was 14.83 days. Conclusion Emergency repair of complicated umbilical hernia in patients with decompensated chronic liver disease is associated with high morbidity and mortality. Contributing factors include increased ascites, portal hypertension, and liver decompensation following surgery. Preoperative optimization and intraoperative ascites drainage may play a crucial role in improving outcomes, even in emergency settings.
失代偿期慢性肝病合并复杂脐疝是发病和死亡的重要原因。本研究评估了急诊脐疝修补术后的管理策略及预测预后的因素。方法：对2024年7月至12月间在肝胆胰（HPB）外科急诊就诊的6例失代偿期慢性肝病合并复杂脐疝患者进行回顾性分析。回顾术前特征、术中发现及术后结果。结果：共纳入6例患者。平均年龄为51.16岁（范围：44 - 58岁），均有腹痛（6例，100%）。其中，2例（33.3%）为绞窄性脐疝，2例（33.3%）为梗阻性疝，2例（33.3%）为破裂疝合并腹水渗漏。所有患者（6例，100%）均接受了急诊手术。3例（50.0%）患者需要行肠切除术，其中2例（33.3%）行一期吻合，1例（16.7%）行双腔回肠造口术。所有6例（100%）患者均未放置补片进行疝缺损的一期修补。4例（66.7%）患者术后恢复顺利；1例（16.7%）患者出现腹水渗漏，1例（16.7%）死亡。术后平均住院天数为14.83天。结论：失代偿期慢性肝病患者急诊修补复杂脐疝的发病率和死亡率较高。促成因素包括腹水增加、门静脉高压及术后肝脏失代偿。术前优化和术中腹水引流即使在急诊情况下也可能对改善预后起关键作用。
