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Case 40: Abdominal distension.

This man was being treated for disseminated gastric cancer. He had widespread peritoneal disease.

1. What are the two likely causes for such an appearance at the umbilicus?

1. Umbilical hernia.

2. Sister Joseph Nodule - of tumour at the umbilicus from peritoneal spread

2. If this was incarcerated small bowel, how would you proceed?

Open repair with possible small bowel resection if required. Tha ascites should be drained through a separate drain to allow the wound to heal before establishing an ascitic fistula.