Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 3 2023 12 03 121 125 Abu Abbasi Loyola University Medical Center, Maywood, IL, USA Paul Hong Loyola University Medical Center, Maywood, IL, USA Aleksandra Marinkovic Saint James School of Medicine, Anguilla, BWI Adekunle Sanyaolu D'Youville University, Buffalo, NY, USA Ikponmwosa Enofe Loyola University Medical Center, Maywood, IL, USA 2023 02 03 2023 04 26 Spontaneous paracentesis is a life-threatening complication of liver cirrhosis. Importance of precise and early identification cannot be overstated, as early treatment improves the prognosis and survival. A 78-year-old woman with cirrhosis presented with ascitic fluid gushing out from an umbilical hernia. The patient received intravascular repletion with intravenous albumin, antibiotics, and rapid umbilical herniorrhaphy. Post-operatively, the patient experienced acute kidney injury and portal vein thrombosis, which was corrected with electrolyte replacement and transjugular intrahepatic portosystemic shunt with thrombectomy. The patient recovered completely and was discharged without difficulty. https://crcp.tums.ac.ir/index.php/crcp/article/view/789