the appearance of distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus across the abdomen. It is also a sign of portal hypertension. It is caused by dilation of the paraumbilical veins, which carry oxygenated blood from mother to fetus in utero and normally close within one week of birth, becoming re-canalised due to portal hypertension caused by liver failure.