A 58-year-old man presented with vague abdominal pain in the right hypochondriac region since two months. Physical examination was unremarkable and ultrasonography showed multiple gallstones with thickening of the gallbladder, suggestive of chronic cholecystitis.

Intraoperatively, the patient was found to have a gallbladder mass involving the adjacent liver segment. In addition a firm to hard nodule was found at the umbilicus. Biopsies taken from the mass and the nodule were suggestive of adenocarcinoma of the gallbladder with metastases to the umbilicus. No attempt was made to remove the mass. He was referred for chemotherapy and received 3 cycles of gemcitabine and oxalipatin.

A CT scan done 2 weeks later showed a mass in the gallbladder involving the fundus and the body with infiltration of adjacent liver segments. A 3 cm × 2.2 cm heterogeneously enhancing nodule was also seen at the umbilicus Fig. 1. A PET CT showed increased uptake in the gallbladder fossa, umbilicus and mediastinum.

Fig. 1
figure 1

CT scan showing the heterogeneously enhancing umbilical nodule

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Sister Mary Joseph nodule is an eponym used to describe umbilical metastases. Umbilical metastasis from gallbladder carcinoma are rare and are reported in only 2% of cases. The presence of umbilical metastasis indicates a grave prognosis and is a sign of advanced malignancy which may not be amenable to surgery [1, 2]. The proposed mechanism for the umbilical metastases include spread via the remnant structures like the falciform ligament, direct trans peritoneal spread via the lymphatics which run alongside the obliterated umbilical vein or the hematogenous route.