Cases and Techniques Library (CTL) E247

Strangulated umbilical after esophagogas- troduodenoscopy in a patient with liver and ascites

Umbilical are present in up to 20% Hazem T. Hammad, Venu Chen- of patients with long-standing cirrhosis namaneni, Dina S. Ahmad, and 40% of those with ascites. There are Mohammad Esmadi some case reports of incarcerated umbili- Department of Internal Medicine, cal and diaphragmatic hernias following Division of and colonoscopy. To our knowledge, this is , Columbia, Missouri, USA only the second case of umbilical hernia strangulation following esophagogastro- duodenoscopy (EGD) in the literature [1]. References A 46-year-old white man with a history of 1 Bynum TE, Smalley TK. Rupture of ascitic umbilical hernia during esophagoscopy; an decompensated alcoholic , unusual indirect complication. Gastrointest Fig. 1 Abdominal radiograph showing an um- , refractory ascites, and Endosc 1970; 17: 67–68 umbilical hernia underwent elective out- bilical hernia as a well-circumscribed soft tissue mass and small-bowel dilatation. patient EGD under conscious sedation for Bibliography variceal surveillance. Band ligation was DOI http://dx.doi.org/ performed with no complications. The pa- 10.1055/s-0034-1364883 tient tolerated the procedure well and This case demonstrates hernia incarcera- Endoscopy 2014; 46: E247 was released on the same day. The next tion and strangulation as an extremely © Georg Thieme Verlag KG day he presented to the gastroenterology rare complication following EGD. The Stuttgart · New York clinic with complaints of , probable cause was the increased intra- ISSN 0013-726X , , and irreducible painful abdominal pressure secondary to air in- umbilical hernia. He had neither had a sufflation during the procedure, which Corresponding author bowel movement nor passed flatus since would have led to dilation of small bowel Mohammad Esmadi, MD the procedure. Emergent abdominal loops, thus precipitating the incarcera- One Hospital Dr. radiography (●" Fig. 1) showed small- tion. It is very unlikely that the timing of DC043.00 Health Sciences Center . The patient under- this complication was a coincidence, given Columbia MO 65212 went emergent exploratory laparotomy the chronological order of events and that USA which revealed a small umbilical defect the patient had this hernia for a long time Fax: +1-573-884-5690 with a strangulated loop of small bowel, with no complications. [email protected] which was resected with primary side- to-side stapled anastomosis along with Endoscopy_UCTN_Code_CPL_1AH_2AK umbilical via conventional fascial technique. Competing interests: None This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

Hammad Hazem T et al. Strangulated umbilical hernia after esophagogastroduodenoscopy in a patient with liver cirrhosis and ascites… Endoscopy 2014; 46: E247