Differential Diagnosis for 31 y.o Male with Abdominal Pain and Umbilical Bloody Discharge

• Single Most Likely Diagnosis
  • Umbilical hernia with incarceration and bowel strangulation: This condition is a likely cause given the symptoms of abdominal pain and umbilical bloody discharge. The bloody discharge could indicate bowel ischemia or necrosis due to strangulation.
• Other Likely Diagnoses
  • Omphalitis: An infection of the umbilicus could cause pain and discharge, although bloody discharge is less common.
  • Umbilical endometriosis: A rare condition in males, but endometriosis can cause cyclical pain and bleeding, potentially presenting with umbilical discharge if the umbilicus is involved.
  • Patent urachus with urinary tract infection or stones: A patent urachus could cause umbilical discharge, and if infected or obstructed, could lead to abdominal pain and potentially bloody discharge.
• Do Not Miss Diagnoses
  • Appendicitis with atypical presentation: Although the classic presentation of appendicitis involves pain migrating to the right lower quadrant, atypical presentations can occur, especially if the appendix is retrocecal. Bloody umbilical discharge would be an unusual but possible sign of a perforated appendix.
  • Intestinal obstruction: An obstruction could cause abdominal pain and, if complicated by ischemia or necrosis, could potentially lead to bloody discharge through a hernia or other abdominal wall defect.
  • Intra-abdominal shunt infection or malfunction (if patient has a history of shunt placement): Infection or malfunction of an intra-abdominal shunt could cause abdominal pain and potentially lead to umbilical discharge if the shunt erodes through the abdominal wall.
• Rare Diagnoses
  • Desmoid tumor (aggressive fibromatosis) with umbilical involvement: Desmoid tumors are rare and can cause abdominal pain and potentially umbilical discharge if they involve the umbilicus.
  • Metastatic disease to the umbilicus (Sister Mary Joseph nodule): Although rare, metastatic cancer can present with umbilical nodules or discharge, and should be considered in the differential diagnosis, especially if other signs of malignancy are present.
  • Congenital anomalies of the urachus or omphalomesenteric duct: These anomalies can cause umbilical discharge and, if complicated by infection or obstruction, could lead to abdominal pain.