the natural history for these hernias is progressive enlargement if left untreated and many of these patients undergo elective repair with synthetic mesh for symptomatic or cosmetic reasons . also , the sequelae of potential complications , such as bowel incarceration or strangulation , result in greater morbidity and mortality in cirrhotic patients . this case report discusses one of such patients , who presented with eviscerated bowel through a long - standing umbilical hernia and describes the surgical management employed . a 50-year - old caucasian male with a long - standing history of cirrhosis , secondary to chronic alcohol abuse and hepatitis c infection , presented to the emergency department with evisceration of his small bowel through an existing umbilical hernia ( fig .  1 ) . the patient had a complicated course of liver disease marked by recurrent ascites and hepatic encephalopathy . two years prior , the patient had his umbilical hernia primarily repaired ; however , he developed a recurrence of the umbilical hernia secondary to recurrent and refractory ascites . the patient stated that he suddenly noticed protrusion of bowel through his umbilical skin after a sudden coughing bout several hours prior to presentation . the patient also reported copious drainage of ascitic fluid through the hernia site following the evisceration . following his surgery , the patient spent 7 days in the icu after which he was transferred to a medical  surgical floor and subsequently discharged with normal bowel function and in stable condition . patients with ascites in the setting of cirrhosis have an 20% chance of developing an umbilical hernia . in the presence of persistently increased intra - abdominal pressure , points of weakness in the abdominal wall are potential sites of herniation . the linea alba is discontinuous at the umbilicus and thus is one point of weakness . furthermore , this patient had an albumin level of 1.8 g / dl suggesting chronic nutritional deficits that could potentially lead to weakened abdominal fascia . evisceration of small bowel through an existing umbilical hernia is a rare and potentially fatal complication of umbilical hernia in the presence of recurrent ascites . there is a reported case of omental evisceration through an umbilical hernia in a patient with a similar history of cirrhosis and hepatitis c . similar to our patient , this occurred following an acute increase in intra - abdominal pressure . evisceration of abdominal contents puts the patient at risk for incarceration , infection and necrosis . a 2011 study performed by erasmus university researchers found that surgical repair of an umbilical hernia in a patient with ascites due to cirrhosis is preferable to conservative treatment . the complications of the umbilical hernia appear to be a greater cause of mortality and morbidity than the surgical repair . in summary , small bowel evisceration is a rare but serious and potentially fatal complication of umbilical hernia in cirrhotic patients with refractory ascites . this case is the first - in - literature depicting spontaneous evisceration of bowel in a cirrhotic patient with a recurrent umbilical hernia .
umbilical hernia in the cirrhotic patient is frequently seen in the setting of refractory ascites . 
 this article reports a rare case of spontaneous rupture of a recurrent umbilical hernia in a patient with persistent ascites , following an acute increase in intra - abdominal pressure , leading to bowel evisceration . 
 this case highlights a potentially fatal complication of umbilical hernia in the setting of chronic ascites , which was successfully managed with prompt surgical intervention .