Presentation
Incidental finding in a patient with sudden, severe abdominal pain.
Patient Data
Features of cirrhosis and portal hypertension with multiple venous collaterals especially around the spleen (portosystemic shunts). Recannalized paraumbilical vein entering an umbilical hernia containing fat.
Caput medusa (i.e. leash of abnormal veins).
Medusa By Carvaggio
Author: Michelangelo Merisi da Caravaggio or Caravaggio (1573(1573)–1610(1610))
Original file: http://commons.wikimedia.org/wiki/File:Medusa_by_Carvaggio.jpg
Modifications: background and drop shadow (by Frank Gaillard).
License: This image (or other media file) is in the public domain because its copyright has expired. This applies to the United States, Australia, the European Union and those countries with a copyright term of life of the author plus 70 years.
Case Discussion
The caput medusae sign (head of Medusa with multiple serpent-like veins in the umbilicus) reflects portal hypertension, with the umbilicus being the endpoint for the recanalized paraumbilical vein (in this case highlighted by the fat-containing umbilical hernia). These veins are at a higher pressure than normal and thus are prone to hemorrhage with minimal trauma. Indeed, in some cases, this can be fatal due to the associated coagulopathy of chronic liver disease.
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