Sister Mary Joseph's nodule: Three case reports.

BACKGROUND: An umbilical metastatic lesion is called 'Sister Mary Joseph's nodule'. It is an uncommon clinical or radiographic finding, and it is rare as the first sign of a malignant disease. CASE PRESENTATION: We report three cases of Sister Mary Joseph's nodule. In the three cases presented, the primary tumor was an adenocarcinona of the sigmoid colon, a carcinoma of the bladder, and an adenocarcinoma of the gallbladder, respectively. CONCLUSION: The differential diagnosis of an umbilical lesion should always include metastatic disease apart from benign lesions and primary neoplasms.

Congenital diaphragmatic hernia complicated by tension gastrothorax during gastroscopy: report of a case.

Bochdalek's hernia typically manifests early in childhood, but it is uncommon in adults. We report the case of a 77-year-old woman who suffered sudden acute cardiorespiratory distress during an upper gastro-intestinal endoscopy, caused by a massive gastrothorax, confirmed by a chest radiograph and thoracic computed tomography. Laparotomy revealed a posterolateral diaphragmatic defect and an acutely distended stomach occupying the left hemithorax, caused by an incomplete organoaxial volvulus of the organ. The stomach was reduced and secured inside the abdominal cavity by a Nissen fundoplication and the defect was repaired with interrupted sutures. Unfortunately, the patient succumbed to generalized sepsis resulting from Pneumocystis carinii bilateral pneumonia. To our knowledge, this is the first reported case in the English literature of an adult with a congenital posterolateral hernia presenting in this manner. However, it demonstrates that a symptomatic congenital diaphragmatic hernia should be surgically repaired to prevent the numerous complications that may arise, many of which can prove fatal even in an adult.