Article Text

Download PDFPDF
An elderly man with chronic poor appetite
  1. Hiroki Matsuura1,2,
  2. Hiroyuki Kageyama3
  1. 1 Emergency Medicine, Okayama City Hospital, Okayama, Japan
  2. 2 General Internal Medicine, Okayama City Hospital, Okayama, Japan
  3. 3 Gastroenterology, Okayama City Hospital, Okayama, Japan
  1. Correspondence to Dr Hiroki Matsuura, Genral Internal Medicine, Okayama Citizen's Hospital, Okayama, Japan; superonewex0506{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Clinical introduction

A 77-year-old man with a 6-month history of poor appetite, nausea, weakness, and progressive weight loss presented to our outpatient department. He had no significant gastrointestinal or cardiovascular problems. Abdominal findings are pictured in figure 1.

Figure 1

Photograph of the patient’s umbilicus.


What is the most likely diagnosis?

  1. Omphalitis

  2. Umbilical abscess

  3. Urachal remnant

  4. Umbilical metastasis (Sister Mary Joseph’s nodule)

Answer: D

His abdominal findings showed conjunctival pallor and a firm, painless, blackish nodule on the umbilicus suggestive as umbilical metastasis (figure 2).

Figure 2

Umbilical findings showed a firm, painless and blackish nodule.

Umbilical metastasis, also called Sister Mary Joseph’s nodule, presents as a painless, blackish …

View Full Text


  • Contributors HM contributed to writing of the manuscript, discussion, patient care and diagnosis. HK contributed to discussion and patient care.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.