Flood syndrome managed by partial splenic embolization and percutaneous peritoneal drainage

Flood syndrome is a rare but recognized complication of advanced liver cirrhosis. It occurs when ascitic fluid drains externally through a ruptured umbilical or incisional hernia. Prior research has shown that this condition leads to rapid fluid loss and can cause significant hemodynamic instability. No prior work had resolved the optimal management strategy for this syndrome. Established knowledge includes the use of diuretics and ascites drainage, but long-term control remains challenging. This gap motivated the exploration of alternative interventions like partial splenic embolization. The condition is poorly understood due to its rarity. That uncertainty drove the need for a case-based approach to evaluate novel treatment options.

The aim of this case report is to describe the management of Flood syndrome using a combination of partial splenic embolization and percutaneous peritoneal drainage. The specific problem is the lack of standardized treatment protocols for this rare condition. The motivation comes from the limitations of conventional therapies in controlling portal hypertension and ascites. The study focuses on a 70-year-old patient with decompensated cirrhosis and a ruptured incisional hernia. The goal is to evaluate the effectiveness of these interventions in reducing ascites and stabilizing the patient. The authors propose that these methods may offer a new approach to managing this syndrome. No prior work had resolved the best interventional strategy for such cases. This case provides insight into a potential treatment pathway.

The patient was initially managed with an ostomy bag and diuretics to reduce ascites. On the 8th day of hospitalization, a 16 Fr percutaneous drain was placed in the left lower quadrant to divert fluid from the abdominal wall defect. On the 13th day, an 80% partial splenic embolization was performed to reduce portal hypertension. The hepatic venous pressure gradient was measured before and after the procedure. The drain was removed on the 16th day, and the patient was discharged on the 22nd day. No additional surgical interventions were performed during this period. The interventions were monitored for clinical response and complications. The study used a combination of radiological and clinical assessments to evaluate outcomes.

After partial splenic embolization, the hepatic venous pressure gradient decreased from 28 to 21 cm H₂O. The percutaneous drain remained in place for six days before removal. The patient showed clinical improvement and was discharged on the 22nd day. No major complications were reported following either intervention. The external drainage of ascites ceased after the drain was removed. The authors suggest that the combination of PSE and percutaneous drainage may have contributed to the patient’s stabilization. The reduction in portal pressure is a key finding supporting the effectiveness of PSE. The clinical course indicates that these interventions may be a viable management option for Flood syndrome.

The authors propose that partial splenic embolization and percutaneous peritoneal drainage may be useful options for managing Flood syndrome. The reduction in hepatic venous pressure gradient supports the potential benefit of PSE in this context. The clinical improvement observed in the patient suggests that these interventions may offer a viable treatment pathway. No essential role was assigned to either intervention beyond what was observed in this case. The authors do not claim that these methods are universally superior but suggest they may be considered in specific cases. No prior work had resolved the best interventional strategy for such cases. The findings are limited to this single case and cannot be generalized. The authors emphasize the need for further studies to confirm these results.