Umbilical hernias are a common complication of persistent ascites. Spontaneous rupture of these hernias is a less common complication. We report a case of spontaneous evisceration through an umbilical hernia in a cirrhotic patient with chronic ascites. Definitive surgical repair of the evisceration was not possible secondary to persistent ascites that was refractory to paracentesis and diuresis. Transjugular intrahepatic portocaval shunt (TIPS) placement was ultimately performed in an attempt to eliminate the ascites fluid. This case demonstrates a rare, but life-threatening complication of abdominal ascites that may be prevented by aggressive medical and surgical management.