Sister Mary Joseph’s nodule as a first sign of an advanced left colon adenocarcinoma, an exceptional clinical situation: A Case Report.

Background Sister Mary Joseph’s nodule is a malignant metastatic umbilical nodule. Sister Mary Joseph Dempsey (1856–1939) was the first to notice the association between intra-abdominal or pelvic cancers and metastatic umbilical nodules. It is a rare clinical sign but an important physical finding as it is a sign of an advanced stage of malignancy with a poor prognostic. Case Presentation: We report the case of a 34-year-old female with a 2-month history of an umbilical nodule (2cm) admitted to the emergency department for acute bowel obstruction. A CT scan showed a thickening of the descending colon wall associated with peritoneal carcinomatosis and a large nodule of carcinomatosis that compressed the last ileal loop, responsible for bowel obstruction. A CT scan also showed an enhanced umbilical mass infiltrating the abdominal wall. Palliative surgery was indicated in emergencies to manage bowel obstruction. Surgical exploration revealed generalized peritoneal carcinomatosis and a large nodule of carcinomatosis obstructing the last ileal loop. Ileostomies and biopsies of the carcinomatosis were performed. Histopathological examination of the carcinomatosis biopsy revealed a moderately differentiated adenocarcinoma of colic origin. The patient was referred to the oncology department for chemotherapy with good courses. Conclusion Sister Mary Joseph’s nodule is a rare first manifestation of colon cancer. The diagnosis is often difficult, which causes delays in the diagnosis. Early detection requires the biopsy of any nodule or umbilical mass to determine its nature. Conservative treatment should be preferred at surgical treatment, except in emergency surgical indications.