Pericardiectomy causing abdominal hernia incarceration

A 26-year-old Rwandan male presented with constrictive pericarditis, massive ascites and a giant umbilical hernia that had been asymptomatic for over a decade. Successful pericardiectomy was complicated by prompt incarceration of the abdominal hernia. This unexpected complication was caused by rapid resolution of the ascites due to autodiuresis and subsequent collapse of the hernial orifice. Patients with constrictive pericarditis and massive ascites who are evaluated for pericardiectomy should be carefully examined for the presence of abdominal hernias. If any such hernias are found, perioperative hernia repair should be considered and postoperative diuresis should be undertaken under close observation.