A 94-year-old male patient, with previous history of atrioventricular block carrying a pacemaker and right inguinal hernioplasty, and recent history of a painless umbilical nodule suspicious of umbilical granuloma, presented to the Emergency department with a 24-hour history of vomiting, diffuse abdominal pain, and abdominal distension. On physical examination, abdominal distension, tympanism, and the referred umbilical nodule (Fig. 1A) were noted. Blood test showed a normal red and white blood cell count, a creatinine level of 1.49 mg/dl, and slightly elevated LDH (299 UI/l), C-reactive protein (2.40 mg/dl) and venous lactate (2.90 mmol/l).
