Differential Diagnosis for Discharge and Pain around the Umbilicus
Single Most Likely Diagnosis
- Umbilical Hernia: This condition is a common cause of pain and discharge around the umbilicus, especially if the hernia becomes incarcerated or strangulated. The discharge could be due to a complication such as infection or bowel obstruction.
Other Likely Diagnoses
- Omphalitis: An infection of the umbilicus, which can cause pain, redness, swelling, and discharge. It's more common in newborns but can occur in adults, especially if there's a history of umbilical piercing or other trauma.
- Pilonidal Sinus or Cyst: Although typically found near the tailbone, some cases can occur near the umbilicus, leading to discharge and pain due to infection.
- Sebaceous Cyst: These can become infected, leading to pain, swelling, and discharge. They are common in areas with high sebaceous gland concentrations, including the umbilical area.
Do Not Miss Diagnoses
- Appendicitis (with atypical presentation): Although appendicitis typically presents with pain in the lower right abdomen, atypical presentations can occur, especially in retrocecal appendicitis, where the pain might be more central or even around the umbilicus.
- Intestinal Obstruction: This can cause severe abdominal pain and, if due to a hernia or adhesions near the umbilicus, could potentially cause discharge if there's bowel compromise.
- Intra-abdominal Shunt Infection (in patients with a ventriculoperitoneal shunt): Patients with a history of hydrocephalus treated with a VP shunt can develop shunt infections, which might present with abdominal pain, fever, and potentially discharge around the umbilicus if the shunt erodes through the skin.
Rare Diagnoses
- Patent Urachus: A congenital anomaly where the tube connecting the bladder to the umbilicus fails to close, potentially leading to discharge of urine from the umbilicus.
- Umbilical Endometriosis: A rare form of endometriosis where endometrial tissue grows in the umbilical scar, leading to cyclical pain and potentially discharge.
- Desmoid Tumor: A rare, benign tumor that can occur in the abdominal wall, including near the umbilicus, potentially causing pain and, if infected or ulcerated, discharge.