Emergency Cases Northwest Group

026 Cart Before Horse

Situation

Physical examination confirmed umbilical metastatic node.

Background

Elderley lady with known uterine cancer, mets presented with abdominal pain. She happened to have an outpatient CT that same day that showed “Sister Mary Joseph” sign. Knowing this I examined her and indeed palpated a small hard nodule deep to the umbilicus.

Assessment

Usually CT confirms your physical examination but in this case it was the other way around!

Sister Mary Joseph sign is an umbilical metastasis presenting as a nodule:

in the umbilicus or deep to it or near it

it may or may not be tender

it may or may not be discoloured or discharging

It can be caused by numerous forms of intra-abdominal cancer and is an uncommon sign.

Recommendation

Remember to palpate the umbilicus in your abdominal examination.

If you feel a nodule there consider an intra-abdominal cancer or its recurrence; investigate accordingly; biopsy, CT etc.

Bear in mind the differentials such as a hernia and other non-cancerous lesions.

PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group