Spontaneous Evisceration Through Umbilical Hernia in Adult Patients: A Scoping Review of Pathophysiology, Clinical...

Background and Objectives: Few cases of spontaneous evisceration through umbilical hernia (UH) in adult patients have been reported in the literature. Although uncommon, it is a potentially life-threatening surgical emergency. This scoping review aimed to map the published cases and summarize the reported clinical settings, precipitating factors, pathophysiologic mechanisms, management strategies, and outcomes. Materials and Methods: A scoping review was conducted in accordance with the PRISMA-ScR guidelines. The search was conducted through PubMed/MEDLINE and Scopus using the strings ("spontaneous evisceration" OR "spontaneous bowel evisceration" OR "umbilical hernia rupture" OR "umbilical hernia evisceration" OR "bowel evisceration umbilical" OR "umbilical evisceration" OR "bowel evisceration" OR "umbilical eventration"). Reports describing spontaneous evisceration of abdominal content through an UH in adult patients were included, whereas pediatric cases, non-umbilical eviscerations, traumatic eviscerations, animal studies, duplicates, and reports without extractable clinical data were excluded. Results: From the initial 2623 records identified, after thorough screening and reference tracking of the selected publications, 47 relevant reports for a total of 49 patients were identified. Cirrhosis was reported in 26 patients (53%), umbilical skin changes before the evisceration in 33 (67%), and death in 10 (20%). Conclusions: The available evidence suggests that spontaneous evisceration through UH is a surgical emergency that should be viewed not merely as a local mechanical event, but as the result of a multistep process involving chronic pressure overload, tissue fragility, and systemic decompensation, frequently in the setting of cirrhosis with ascites. Urgent repair is usually required, but the role of mesh reinforcement remains unclear and should be individualized according to contamination, defect size, patient condition, and ascites control.