title: Umbilical hernia rupture with evisceration of omentum from massive ascites: a case report.
abstract: BACKGROUND
  The incidence of hernias is increased in patients with alcoholic liver disease with ascites. To the best of our knowledge, this is the first report of an acute rise in intra-abdominal pressure from straining for stool as the cause of a ruptured umbilical hernia.
  
  
  METHODS
  An 81-year-old Caucasian man with a history of alcoholic liver disease presented to our emergency department with an erythematous umbilical hernia and clear, yellow discharge from the umbilicus. On straining for stool, after initial clinical assessment, our patient noted a gush of fluid and evisceration of omentum from the umbilical hernia. An urgent laparotomy was performed with excision of the umbilicus and devitalized omentum.
  
  
  CONCLUSIONS
  We report the case of a patient with a history of alcoholic liver disease with ascites. Ascites causes a chronic increase in intra-abdominal pressure. A sudden increase in intra-abdominal pressure, such as coughing, vomiting, gastroscopy or, as in this case, straining for stool can cause rupture of an umbilical hernia. The presence of discoloration, ulceration or a rapid increase in size of the umbilical hernia signals impending rupture and should prompt the physician to reduce the intra-abdominal pressure.
authors.affiliation: Minimally Invasive Surgical Unit, Division of Colorectal Surgery, AMNCH, Tallaght, Dublin 24, Ireland. goodd@tcd.ie.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Good
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Royds
authors.forename: Myles J
authors.initials: MJ
authors.lastname: Smith
authors.forename: Paul C
authors.initials: PC
authors.lastname: Neary
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Eguare