Transcatheter arterial embolization for postoperative hemorrhage complicating surgical repair of incarcerated umbilical hernia subsequent to Denver peritoneovenous shunting: A case report

Abstract

A 50-year-old man with a refractory ascites was inserted a peritoneovenous shunt under local anesthesia. On the fifth postoperative day, abdominal pain occurred and were diagnosed as incarcerated umbilical hernia. Due to unsuccessful manual reduction, emergent hernia repair was performed. Postoperatively, wound bleeding was not controlled, and endovascular treatment was planned because enhanced computed tomography detected arterial extravasations. Bilateral inferior epigastric arteries were embolized with a 33.3% n-butyl-2-cyanoacrylate lipiodol mixture. The patient's symptoms subsequently improved without complications. Patients with refractory ascites develop incarcerated umbilical hernia after the decompression procedure, such as a peritoneovenous shunt. The coagulopathy caused by the Denver peritoneovenous shunt makes perioperative bleeding control difficult. Therefore, physicians should be aware that laparotomy performed after Denver peritoneovenous shunting sometimes requires transarterial embolization for hemostasis.

Keywords

• Case report
• Coagulopathy
• Denver peritoneovenous shunt
• Transarterial embolization
• Umbilical hernia