To the Editor.—We have inserted seven peritoneovenous shunts in six patients, five of whom had umbilical hernias at the time of surgery. Three of these patients have had postoperative complications, an important incidence in this small series. The obvious reason for this is that, with the distended abdomen secondary to the massive ascites, the hernia ring is stretched so that the chances of incarceration are not great. However, as the abdomen becomes decompressed, the ring narrows down in size, increasing the likelihood of incarceration.
Report of Cases.—Case 1.—A 47-year-old man underwent insertion of a peritoneovenous shunt. He had a rapid 11.25-kg weight loss and a 20-cm loss of abdominal girth. Preoperatively, he had an umbilical hernia that easily admitted four fingers through the ring. About 1½ months postoperatively, he had a sudden onset of umbilical pain. He had an obviously incarcerated umbilical hernia. At the time of