Abstract:Small bowel perforation is a life threatening event. Clinically, it presents catastrophically as an acute abdomen and rapidly progressive multi organ failure in the absence of early diagnosis and management. In neonates and children, erythema of and around the umbilical region has been described as an ominous sign, that point toward direful intraabdominal pathology. Here we present a similar sign (red umbilicus) in an adult cirrhotic, in whom early assumption led to swift diagnosis of intestinal perforation.