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Pericardiodiaphragmatic hernia with faecal fistula

findings suggested a perforated tumour of the ascending colon with a loculated collection. A CT of the chest showed a 23-mm lobulated mass in the right lung mid-zone, possibly a pulmonary metastasis. The patient needed a tissue biopsy, which could have been performed in several ways. The options are CT-guided biopsies on the lesions (lung, liver or tumour itself) with risks, open biopsy of Sister Joseph nodule, colonoscopic biopsy of colonic lesion and laparoscopy. We performed a diagnostic laparoscopy, which showed an abnormal omentum; however, biopsies of omentum did not show any malignancy. The abdominal wall lump was a multiloculated Swiss cheese type of hernia. One hernial sac containing omental nodule was excised, the histology of which revealed an adenocarcinoma. The case was discussed in a multidisciplinary meeting and the patient was referred to the oncologists for palliative chemotherapy. Sister Mary Joseph nodule is an indurated and firm nodule of the umbilicus and perimubilical region associated with advanced intraabdominal malignancy. The nodule was first described by Baluff in 1854; however, Hamilton Bailey first coined the term ‘Sister Joseph Nodule’. Sister Joseph was a devoted nurse who worked at the Mayo Clinic. Cancers of various organs may present as SJ nodule including ovary, uterus, kidney, colon, stomach, gall bladder and pancreas. The nodule should be biopsied and primary umbilical cancer should be differentiated from metastasis. It indicates a poor prognosis with a survival of less than 1 year.