Caput Medusae Mimicking Umbilical Hernia

A 34-year-old female, a diagnosed case of chronic liver disease, presented to the emergency department with yellowish discoloration of the skin, abdominal distension, and bilateral lower limb swelling for 1 week. She also complained of painless swelling over her umbilicus for the last 6 months. On examination, she was conscious, oriented, and hemodynamically stable. General physical examination revealed icterus and bilateral pitting pedal edema up to the knees. On abdominal examination, the abdomen was distended and shifting dullness was present. A large swelling of approximately 7 × 5 cm was present over the anterior abdominal wall with a palpable thrill and an audible Cruveilhier-Baumgarten murmur (Figs 1A and B). The swelling was not reducible and had no signs of inflammation. The rest of the systemic examination was normal.