We experienced two cases involving the simultaneous presence of cholelithiasis, 
hiatal hernia, and umbilical hernia. Both patients were female and overweight 
(body mass index of 25.0-29.9 kg/m(2)) and had a history of pregnancy and 
surgical treatment of cholelithiasis. Additionally, both patients had two of the 
three conditions of Saint's triad. Based on analysis of the pathogenesis of 
these two cases, we consider that these four diseases (Saint's triad and 
umbilical hernia) are associated with one another. Obesity is a common risk 
factor for both umbilical hernia and Saint's triad. Female sex, older age, and a 
history of pregnancy are common risk factors for umbilical hernia and two of the 
three conditions of Saint's triad. Thus, umbilical hernia may readily develop 
with Saint's triad. Knowledge of this coincidence is important in the clinical 
setting. The concomitant occurrence of Saint's triad and umbilical hernia may be 
another clinical "tetralogy."