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A 44-year-old female presented with 1-year history of progressive abdominal distension (figure 1A) which she thought might be related to pregnancy and a tumour protruding through her umbilical area that was oozing serosanguinous fluid. The patient did not seek medical attention initially due to lack of insurance. CT of the abdomen (figure 1B,C) revealed a large mass with loculated ascites. Multiple lung nodules were identified as well. The patient underwent tumour debulking that revealed a poorly differentiated malignant neoplasm (figure 1D) involving ovaries, the umbilical area and widespread omental metastases. Postoperatively the patient continued to produce massive amounts of ascites and ultimately succumbed due to sepsis.
Sister Mary Joseph’s nodule, or a metastatic lesion of the umbilicus, was coined in 1949 by the english surgeon Sir Hamilton Bailey1 after Sister Mary Joseph (1856–1939), a surgical assistant for Dr William Mayo2, who was the first to associate intra-abdominal malignancy and the umbilical lesions while cleaning the skin of patients before surgery.
Competing interests None.
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