Percutaneous transabdominal plug-assisted antegrade and retrograde transvenous embolization for the treatment of ruptured paraumbilical varices with concurrent flood syndrome - A case report

Sep 28, 2026

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Ruptured paraumbilical varices and Flood syndrome (umbilical hernia rupture with ascites leakage) are both life-threatening, each associated with >30% mortality. Their co-occurrence requires immediate portal decompression and variceal hemostasis. This report describes a 52-year-old man with alcohol-related cirrhosis who had concurrent paraumbilical variceal rupture and Flood syndrome with massive ascites and blood leakage. A TIPS combined with direct percutaneous transvenous paraumbilical embolization enabled rapid bleeding control and eventual survival; direct percutaneous access overcame tortuous anatomy and difficult venous manipulation.

LanguageEnglish

CategoryHealthcare

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Pages6

Reading Time15 min

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Background

Case report

Radiology Ca s e Reports 21 (2026) 1043 – 1048 Available online [at](at www.sciencedirect.com)[ www.sciencedirect.com](at www.sciencedirect.com) journal [homepage:](homepage: www.elsevier.com/locate/radcr)[ www.elsevier.com/locate/radcr](homepage: www.elsevier.com/locate/radcr) | Case Report
Percutaneous transabdominal plug-assisted antegrade and retrograde transvenous embolization for the treatment of ruptured paraumbilical varices with concurrent flood syndrome: A case report ✩,✩✩
Sean Rogers, MDa, QuynhAnh Phan, BSb, Anita Krishnarao, MDc, Neil J. Resnick, MD, FSIRa, Ningcheng (Peter) Li, MD, MSa,∗
a Division of Interventional Radiology, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA
b University of Massachusetts Chan Medical School, Worcester, MA, USA
c Division of Gastroenterology, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA | | | --- | --- | | a r t i c l e i n f o | a b s t r a c t
Ruptured paraumbilical varices and Flood syndrome (umbilical hernia rupture with ascites leakage) are both life-threatening conditions, each carrying >30% mortality. Co-occurrence of the 2 requires immediate portal decompression and variceal hemostasis for a chance of survival. This report presents a case of concurrent paraumbilical variceal rupture and Flood syndrome with massive leakage of ascites and blood in a 52-year-old male with alcoholrelated cirrhosis. A strategy combining transjugular intrahepatic portosystemic shunt (TIPS) with direct percutaneous transvenous paraumbilical variceal embolization enabled immediate cessation of bleeding and eventual survival. Direct percutaneous transvenous access was the key to rapid hemostatic control, overcoming tortuous anatomy and difficult venous manipulation. This technique expands therapeutic options for complex ectopic varices and supports the safety of direct percutaneous access for portal interventions.
© 2025 The Authors. Published by Elsevier Inc. on behalf of University of Washington.
This is an open access article under the CC BY-NC-ND license
([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)) | | Article history:
Received 27 August 2025 Revised 31 October 2025 Accepted 9 November 2025 | | | Keywords:
TIPS
Flood syndrome Paraumbilical variceal bleeding Portal hypertension
Cirrhosis | | Abbreviations: TIPS, transjugular intrahepatic portosystemic shunt; SMV, superior mesenteric vein. ✩ Competing Interests: The authors have declared that no competing interests exist. ✩✩ Acknowledgements: None. ∗ Corresponding author at: 55 Lake Avenue N, Worcester, MA 01655. E-mail [address:](address: Ningcheng.Li@umassmed.edu)[ Ningcheng.Li@umassmed.edu](address: Ningcheng.Li@umassmed.edu) (N.(. Li). [https://doi.org/10.1016/j.radcr.2025.11.033](https://doi.org/10.1016/j.radcr.2025.11.033) 1930-0433/© 2025 The Authors. Published by Elsevier Inc. on behalf of University of Washington. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)) Background Ectopic varices and umbilical hernia rupture are infrequent sequelae of portal hypertension, both with potentially lifethreatening consequences. Mortality from the initial bleeding episode of ectopic varices has been reported up to 40%[1]. Mortality from ruptured umbilical hernias resulting in outpouring of ascitic fluid, a condition termed Flood syndrome and seen in up to 20% of cirrhotic patients with long-standing ascites [2], has been reported up to 30%[3] . This report presentsa case of life-threatening paraumbilical variceal rupture with concurrent Flood Syndrome, 2 conditions with high mortalities and morbidities, and a direct percutaneous approach in addition to the creation of transjugular intrahepatic portosystemic shunt (TIPS) for

FAQs

What clinical scenario requires urgent portal decompression and variceal hemostasis?

Concurrent ruptured paraumbilical varices and Flood syndrome require immediate portal decompression and variceal hemostasis because both conditions carry high mortality.

What approach was used to control bleeding in the reported case?

The case combined transjugular intrahepatic portosystemic shunt (TIPS) with direct percutaneous transvenous paraumbilical variceal embolization to achieve immediate cessation of bleeding.

Why was direct percutaneous transvenous access emphasized?

Direct percutaneous access enabled rapid hemostatic control by overcoming tortuous anatomy and difficult venous manipulation, supporting its safety for complex portal interventions.

Sep 28, 2026

Uploaded by Aran