Incidental finding in a patient with sudden, severe abdominal pain.
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Features of cirrhosis and portal hypertension with multiple venous collaterals especially around the spleen (porto-systemic shunts). Recannalized paraumbilical vein entering an umbilical hernia containing fat where there is a caput medusa (i.e. leash of abnormal veins)
Caput medusa (head of Medusa with multiple serpent-like veins in the umbilicus) reflects portal hypertension with the umbilicus being the end point for the recanalized paraumbilical vein (in this case highlighted by the fat containing umbilical hernia). These veins are at higher pressure than normal thus are prone to haemorrhage with minimal trauma. Indeed in some cases this can be fatal due to the associated coagulopathy of chronic liver disease.