Umbilical hernia incarceration: a complication of medical therapy of ascites.

Umbilical hernias occur frequently among patients with cirrhosis and ascites. Common complications include incarceration, leakage, and rupture. Two patients experienced umbilical hernia incarceration while undergoing medical therapy of their massive ascites--a complication not previously described. Decompression of ascites apparently causes decreased tension on the umbilical hernia ring with subsequent trapping of the hernia sac contents. Mortality of incarcerated umbilical hernias is significant (3-14%). Patients receiving medical therapy for ascites should be examined carefully for the presence of umbilical hernias and, if present, the hernias should be observed closely during the course of treatment.