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. 2025 Apr 19;17(4):e82578.
doi: 10.7759/cureus.82578. eCollection 2025 Apr.

Management and Outcomes of Umbilical Hernia in Decompensated Chronic Liver Disease: A Single-Unit Experience of Six Cases

Karamveer Singh  1 , Manoj Joshua Lokavarapu  2 , Nayana S Kumar  2 , Amit Gupta  2 , Arunkumar V  2 , Dipendra Singh  2 , Vatsala Singh  3 , Mohammad Shahid Raja  2 , Satish Ammapalem  2 , Monisha Selvarasu  2
Affiliations

Management and Outcomes of Umbilical Hernia in Decompensated Chronic Liver Disease: A Single-Unit Experience of Six Cases

Karamveer Singh et al. Cureus. .

Abstract

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.

Keywords: decompensated chronic liver disease; emergency hernia repair; end-stage liver disease; transjugular intrahepatic portosystemic shunt; umbilical hernia.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. All India Institute of Medical Sciences, Rishikesh Institutional Ethics Committee issued approval AIIMS/RISH/GS/2025-246. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Clinical and Intraoperative Findings in a Patient with Strangulated Umbilical Hernia with Decompensated Chronic Liver Disease.
(A) Clinical photograph of Patient 1 presenting with a strangulated umbilical hernia, showing overlying skin changes indicative of compromised perfusion. (B) Intraoperative photograph of Patient 1 demonstrating a gangrenous segment of the ileum, necessitating resection. (C) Intraoperative photograph of Patient 1 revealing a cirrhotic liver with a nodular surface and altered texture, consistent with chronic liver disease. Picture credits: Ammapalem Satish
Figure 2
Figure 2. Clinical photograph of Patient 3 showing an umbilical hernia with evisceration of omentum through a ruptured hernial sac
Picture credits: Ammapalem Satish
See this image and copyright information in PMC

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