SISTER MARY JOSEPH NODULE, CASE REPORT

M Al-Sheikh, N Naguib, A Saklani

Abstract


A 82 year old woman presented to Accident and Emergency department feeling generally unwell with loss of appetite. Three days later she started to complain of abdominal pain and vomiting. There were no associated fevers or night sweats. Physical examination revealed generalised abdominal tenderness and distension. There was an umbilical nodule, with some umbilical discharge. This was initially diagnosed as small para-umbilical hernia. Two days later she developed intestinal obstruction which was confirmed by a plain abdominal x-ray (fig1). CT scan showed marked dilatation of the caecum with fluid level, ill defined thickening in the hepatic flexure region with small amount of ascites. Re-examination of umbilicus intra operatively confirmed the presence of Sister Marie Joseph nodule, (fig2 ). Laparotomy revealed an obstructed hepatic flexure tumor with  distended ischemic Caecum impeding perforation. There were multiple metastatic peritoneal and mesenteric nodules. Palliative Right Hemicolectomy was performed.. Histo-pathology confirmed the presence of Mucinous Adenocarcinoma , Dukes C1, stage T4 N2 M1, with metastatic deposit in  the umbilicus. Post-operatively the patient was transferred to the ITU. She could not be weaned off the ventilator and in view of her advanced disease, escalation of treatment was not carried out.


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