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We describe two cases of recurrent major umbilical bleeding in male patients with Childs A liver cirrhosis and portal hypertension. Both patients had umbilical hernias with omentum incarcerated in the hernial sac. In both cases, portosystemic abdominopelvic CT scan had shown omental varices without significant paraumbilical cutaneous varices. Previous reports have shown that venous communication can develop between omental varices and overlying abdominal wall scars, resulting in spontaneous cutaneous bleeding. We concluded that there was a similar mechanism for the umbilical bleeding in our cases and both were successfully treated by excising the umbilicus, ligating the omental varices within the hernia sac, returning the omentum to the abdominal cavity and repairing the hernia defect. This cause for umbilical bleeding has not been previously reported. We advise that with similar cases, excision of the umbilicus and ligation of the omental varices is safe and effective treatment.Umbilical bleeding is a well recognised but rare complication of portal hypertension. In previously reported cases, it has arisen from rupture of umbilical varices that have developed due to portosystemic communication between the recanalised umbilical vein and the periumbilical veins of the abdominal wall.1–8 We present two cases of recurrent major umbilical bleeding from omental varices incarcerated within an umbilical hernia. Both cases were treated successfully with excision of the umbilicus and ligation of the omental varices. This is the first report of umbilical bleeding from omental varices in patients with umbilical hernias and portal hypertension. We wished to raise awareness of this potentially life-threatening condition and have discussed its pathogenesis, investigation and surgical management.### Case 1A 51-year-old man presented with spontaneous bleeding from his umbilicus. He described blood pouring out of his umbilicus as if a tap had been turned on (figure 1). His clothes had become soaked with blood. He had Childs A …

Recurrent major umbilical bleeding caused by omental varices in two patients with umbilical hernia and portal hypertension