This is a patient with polycystic kidney disease who is currently receiving peritoneal dialysis. Despite her large kidneys, she has been doing well on peritoneal dialysis for 3 years until she developed a small para-umbilical hernia. Due to the increased intra-abdominal pressure, patients on peritoneal dialysis may develop hernia or internal fluid leakage (e.g. retroperitoneal or into the patent processus vaginalis). If left untreated, there is risk of bowel herniation and strangulation. A hernia repair was performed and the patient was able to resume peritoneal dialysis.