Man With a Leaking Umbilical Hernia

A 70-year-old man with a history of decompensated cirrhosis requiring weekly paracentesis and an umbilical hernia presented to the emergency department with 1 week of progressive umbilical hernia enlargement with umbilical drainage and overlying skin discoloration, nausea, vomiting, and decreased bowel movements. On arrival, he was afebrile and hemodynamically stable. Abdominal examination revealed distension and a protruding, tense, nontender, erythematous umbilical hernia with overlying skin necrosis and leakage of ascitic fluid (Fig).