1. PATIENT PRESENTATION
A 54‐year‐old male with a past medical history of atrial flutter and alcohol use disorder presents with an umbilical wound of approximately 6 months duration. The patient reports intermittent irritation and minimal drainage of the wound. On examination, the abdomen was soft and non‐tender. An umbilical wound was characterized by an eschar with a central area of crusted tissue easily removed with gentle cleansing No active drainage was noted. Our patient was initially discharged with wound care instructions. He returned 2 months later and was admitted for atrial flutter with congestive heart failure. The patient had a computed tomography chest/abdomen/pelvis that demonstrated likely a pancreatic tail adenocarcinoma with metastasis to the peritoneal and abdominal walls, and the patient declined any further intervention (Figures 1 and 2).
FIGURE 1.
Umbilical lesion on the initial emergency department visit.
FIGURE 2.
Umbilical lesion on the second emergency department visit.
2. DIAGNOSIS
3. Sister Mary Joseph nodule
The Sister Mary Joseph (SMJ) nodule is a rare cutaneous metastasis of gastrointestinal or genitourinary malignancies to the umbilicus. 1 , 2 They are typically firm, painful, indurated, and irregularly shaped, with sizes typically less than 2 cm. 1 They can be ulcerated or necrotic with variable presence of discharge ranging from purulent to serous or serosanguinous. 1 Sister Mary Joseph nodules typically arise late in disease and portend a poor prognosis. 1 Most primary malignancies are adenocarcinomas (75%), and pancreatic cancers represent approximately 9% of umbilical metastases. 1 Mean survival of patients with SMJ nodules is less than 12 months. 1 Sister May Joseph Dempsey was a nun and surgical assistant to Dr. William Mayo, who developed an approach to umbilical hernia repair and first identified the connection between abdominopelvic cancers and umbilical nodules. 2 , 3
Ransford GL, Graffeo CS, Knapp BJ. A no‐nun‐sense umbilical lesion. JACEP Open. 2023;4:e13009. 10.1002/emp2.13009
REFERENCES
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