Strainiene S, Peciulyte M, Strainys T, Stundiene I, Savlan I, Liakina V, Valantinas J. Management of Flood syndrome: What can we do better? World J Gastroenterol 2021; 27(32): 5297-5305 [PMID: 34539133 DOI: 10.3748/wjg.v27.i32.5297]
Corresponding Author of This Article
Valentina Liakina, PhD, Senior Researcher, Clinic of Gastroenterology, Nephrourology and Surgery, Centre of Hepatology, Gastroenterology and Dietetics, Institute of Clinical Medicine, Vilnius University, 21 M.K. Ciurlionio Street, Vilnius 03104, Lithuania. valentina.liakina@santa.lt
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Aug 28, 2021; 27(32): 5297-5305 Published online Aug 28, 2021. doi: 10.3748/wjg.v27.i32.5297
Management of Flood syndrome: What can we do better?
Sandra Strainiene, Milda Peciulyte, Tomas Strainys, Ieva Stundiene, Ilona Savlan, Valentina Liakina, Jonas Valantinas
Sandra Strainiene, Milda Peciulyte, Ieva Stundiene, Ilona Savlan, Valentina Liakina, Jonas Valantinas, Clinic of Gastroenterology, Nephrourology and Surgery, Centre of Hepatology, Gastroenterology and Dietetics, Institute of Clinical Medicine, Vilnius University, Vilnius 03104, Lithuania
Tomas Strainys, Clinic of Anesthesiology and Reanimatology, Centre of Anesthesiology, Intensive Care and Pain Management, Institute of Clinical Medicine, Vilnius University, Vilnius 03104, Lithuania
Valentina Liakina, Department of Chemistry and Bioengineering, Faculty of Fundamental Science, Vilnius Gediminas Technical University, Vilnius 10223, Lithuania
Author contributions: Strainiene S and Peciulyte M wrote the original manuscript and reviewed the literature; Liakina V, Stundiene I, Strainys T, and Savlan I reviewed and edited the manuscript; Savlan I, Liakina V, Stundiene I, and Valantinas J were responsible for revising the manuscript for important intellectual content; All authors issued final approval for this version to be submitted and agree to be accountable for all aspects of this work.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Valentina Liakina, PhD, Senior Researcher, Clinic of Gastroenterology, Nephrourology and Surgery, Centre of Hepatology, Gastroenterology and Dietetics, Institute of Clinical Medicine, Vilnius University, 21 M.K. Ciurlionio Street, Vilnius 03104, Lithuania. valentina.liakina@santa.lt
Received: February 18, 2021 Peer-review started: February 18, 2021 First decision: May 1, 2021 Revised: May 3, 2021 Accepted: August 3, 2021 Article in press: August 3, 2021 Published online: August 28, 2021
Abstract
Approximately 20% of cirrhotic patients with ascites develop umbilical herniation. These patients usually suffer from multisystemic complications of cirrhosis, have a significantly higher risk of infection, and require accurate surveillance– especially in the context of the coronavirus disease 2019 pandemic. The rupture of an umbilical hernia, is an uncommon, life-threatening complication of large-volume ascites and end-stage liver disease resulting in spontaneous paracentesis, also known as Flood syndrome. Flood syndrome remains a challenging condition for clinicians, as recommendations for its management are lacking, and the available evidence for the best treatment approach remains controversial. In this paper, four key questions are addressed regarding the management and prevention of Flood syndrome: (1) Which is the best treatment approach–conservative treatment or urgent surgery? (2) How can we establish the individual risk for herniation and possible hernia rupture in cirrhotic patients? (3) How can we prevent umbilical hernia ruptures? And (4) How can we manage these patients in the conditions created by the coronavirus disease 2019 pandemic?
Core Tip: Flood syndrome is a rare, life-threatening complication of large-volume ascites and end-stage liver disease resulting in a sudden umbilical hernia rupture and spontaneous paracentesis. It remains a challenge for clinicians, as recommendations for the management of this syndrome are lacking. The establishment of the individual risk for herniation and possible hernia rupture, timely prevention, and elective surgical treatment might reduce the risk of complications and the need for urgent surgery.
