# Spontaneous Bowel Evisceration Through Umbilical Hernia Sites in Adult Patients: A Systematic Review of the Literature

## TL;DR

This paper reviews rare cases of spontaneous bowel evisceration through umbilical hernias in adults, highlighting risk factors like liver disease and ascites.

## Contribution

The study systematically compiles and analyzes a limited number of adult cases of spontaneous umbilical hernia evisceration.

## Key findings

- Spontaneous evisceration through umbilical hernias is rare but serious, often linked to liver disease and ascites.
- Treatment approaches remain unclear due to the low number of reported cases.
- Prosthetics may be less advisable in acute cases but could be considered in elective settings for cirrhotic patients.

## Abstract

Background: The literature reports few instances of spontaneous bowel eviscerations through umbilical hernia sites. Spontaneous rupture of the hernia sac is a less common complication, primarily associated with persistent ascites or congenital wall defects. Materials and methods: A systematic review was conducted using the PubMed database—the United States National Library of Medicine, with the search terms “spontaneous bowel evisceration” and “umbilical hernia evisceration”. However, several results were deemed unsuitable for this manuscript. From a total of 185 cases, this review was narrowed down to 9 usable reports. Non-English language cases, duplicates, and cases unrelated to the pathology, including pediatrics, malformations, herniation through other organs, and animal cases, were excluded. Conclusions: Spontaneous evisceration in a hernia is an uncommon yet serious condition. A major risk factor appears to be underlying liver disease with its complications, such as ascites, chronic malnutrition with hypoalbuminemia, and collateral circulation formation. These factors contribute to the susceptibility of the sac and the hernia wall to rupture. However, the limited number of reported cases precludes the establishment of a preferred treatment approach. In the acute phase, the use of prosthetics may be less advisable, but in an elective setting, the cirrhotic patient could be offered repair.