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Spontaneous Perforation of Umbilical Hernia: The Need for Early Herniorrhaphy in Ascites

Spontaneous Perforation of Umbilical Hernia: The Need for Early Herniorrhaphy in Ascites Abstract Abdominal hernia as a concomitant of cirrhosis of the liver has been variously reported as having an incidence of between 16%1 and 42%,2 depending upon the presence of associated ascites. A reasonable hypothesis for the relationship has been offered by Altschule who has suggested that hernias form as a result of a long-standing increase in intra-abdominal pressure. In view of the observation that less than half of patients with large amounts of abdominal fluid form them, a latent congenital defect is a probable precursor.3 Although the commonly encountered hernias are either umbilical or inguinal, both may be found in the same patient. The complications of untreated hernias of this nature are well known and include incarceration of the bowel, with or without strangulation. While spontaneous perforation of an umbilical hernia in infants (omphalocele) has from time to time been recorded in the English literature,4 the condition References 1. Henrikson, E. C.: Cirrhosis of the Liver, with Special Reference to Surgical Aspects , Arch. Surg. 32:413-451, 1936.Crossref 2. Chapman, C. B.; Snell, A. M., and Rowntree, L. G.: Decompensated Portal Cirrhosis: Report of 112 Cases , J.A.M.A. 97:237-244, 1931.Crossref 3. Altschule, M. D.: Hernia as the Presenting Complaint in Patients with Cirrhosis of the Liver and Ascites , New England J. Med. 224:351-352, 1941.Crossref 4. Ray, R. C.: Ruptured Omphalocoele , U.S. Armed Forces M.J. 8:445-448, 1957. 5. Lerner, S., and Rost, M.S.: Spontaneous Abdominal Paracentesis , J.A.M.A. 170:1310-1311, 1959.Crossref 6. Yonemoto, R. H., and Davidson, C. S.: Herniorrhaphy in Cirrhosis of the Liver with Ascites , New England J. Med. 255:733-739, 1956.Crossref 7. Hardinger, J. D., and Noskin, E. A.: Spontaneous Eventration Through the Umbilicus , New England J. Med. 261:141-142, 1959.Crossref 8. Gabuzda, G. J., Jr.; Traeger, H. S., and Davidson, C. S.: Hepatic Cirrhosis: Effects of Sodium Choride Administration and Restriction and of Abdominal Paracentesis on Electrolyte and Water Balance , J. Clin. Invest. 33:780-789, 1954.Crossref 9. Warren, K. W.: Hernias in the Poor Risk Patient: Their Surgical Management , S. Clin. North America 34:761-771. 10. Ferron, E.: Faut-il opérer les hernies des ascitiques cirrhotiques? Mém. Acad. chir. 82:573-575, 1956. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Spontaneous Perforation of Umbilical Hernia: The Need for Early Herniorrhaphy in Ascites

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Publisher
American Medical Association
Copyright
Copyright © 1960 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1960.01300030174023
Publisher site
See Article on Publisher Site

Abstract

Abstract Abdominal hernia as a concomitant of cirrhosis of the liver has been variously reported as having an incidence of between 16%1 and 42%,2 depending upon the presence of associated ascites. A reasonable hypothesis for the relationship has been offered by Altschule who has suggested that hernias form as a result of a long-standing increase in intra-abdominal pressure. In view of the observation that less than half of patients with large amounts of abdominal fluid form them, a latent congenital defect is a probable precursor.3 Although the commonly encountered hernias are either umbilical or inguinal, both may be found in the same patient. The complications of untreated hernias of this nature are well known and include incarceration of the bowel, with or without strangulation. While spontaneous perforation of an umbilical hernia in infants (omphalocele) has from time to time been recorded in the English literature,4 the condition References 1. Henrikson, E. C.: Cirrhosis of the Liver, with Special Reference to Surgical Aspects , Arch. Surg. 32:413-451, 1936.Crossref 2. Chapman, C. B.; Snell, A. M., and Rowntree, L. G.: Decompensated Portal Cirrhosis: Report of 112 Cases , J.A.M.A. 97:237-244, 1931.Crossref 3. Altschule, M. D.: Hernia as the Presenting Complaint in Patients with Cirrhosis of the Liver and Ascites , New England J. Med. 224:351-352, 1941.Crossref 4. Ray, R. C.: Ruptured Omphalocoele , U.S. Armed Forces M.J. 8:445-448, 1957. 5. Lerner, S., and Rost, M.S.: Spontaneous Abdominal Paracentesis , J.A.M.A. 170:1310-1311, 1959.Crossref 6. Yonemoto, R. H., and Davidson, C. S.: Herniorrhaphy in Cirrhosis of the Liver with Ascites , New England J. Med. 255:733-739, 1956.Crossref 7. Hardinger, J. D., and Noskin, E. A.: Spontaneous Eventration Through the Umbilicus , New England J. Med. 261:141-142, 1959.Crossref 8. Gabuzda, G. J., Jr.; Traeger, H. S., and Davidson, C. S.: Hepatic Cirrhosis: Effects of Sodium Choride Administration and Restriction and of Abdominal Paracentesis on Electrolyte and Water Balance , J. Clin. Invest. 33:780-789, 1954.Crossref 9. Warren, K. W.: Hernias in the Poor Risk Patient: Their Surgical Management , S. Clin. North America 34:761-771. 10. Ferron, E.: Faut-il opérer les hernies des ascitiques cirrhotiques? Mém. Acad. chir. 82:573-575, 1956.

Journal

Archives of SurgeryAmerican Medical Association

Published: Sep 1, 1960

References

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