Differential Diagnosis for Periumbilical Pain

The following is a differential diagnosis for periumbilical pain, categorized for clarity and emphasis on critical conditions.

• Single Most Likely Diagnosis

  • Gastroenteritis: This is often the most common cause of periumbilical pain, especially if accompanied by symptoms like diarrhea, vomiting, and fever. The pain is usually diffuse and can be related to eating or bowel movements.

• Other Likely Diagnoses

  • Constipation: Can cause significant abdominal pain, including around the umbilicus, especially if the constipation is severe or chronic.
  • Irritable Bowel Syndrome (IBS): Characterized by recurrent abdominal pain associated with a change in bowel habits, such as diarrhea or constipation.
  • Peptic Ulcer Disease: Although the pain is typically more epigastric, it can radiate or be referred to the periumbilical area, especially if the ulcer is located in the duodenum.
  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause abdominal pain, including in the periumbilical region, along with changes in bowel habits, weight loss, and sometimes blood in the stool.

• Do Not Miss Diagnoses

  • Appendicitis: Although the pain typically starts near the umbilicus and then localizes to the right lower quadrant, some cases can present with pain around the umbilicus. Missing appendicitis can lead to perforation and severe complications.
  • Intestinal Obstruction: Can cause severe, colicky pain around the umbilicus, along with vomiting, constipation, and sometimes fever. This condition requires prompt surgical intervention.
  • Ectopic Pregnancy: Should be considered in women of childbearing age presenting with abdominal pain, especially if there's a history of missed periods or positive pregnancy test. It's a medical emergency.
  • Pancreatitis: Can cause severe, persistent pain in the upper abdomen that may radiate to the back and can sometimes be perceived around the umbilicus.

• Rare Diagnoses

  • Meckel's Diverticulum: A congenital anomaly of the small intestine that can cause pain, usually in the right lower quadrant but can be periumbilical, along with gastrointestinal bleeding.
  • Mesenteric Ischemia: A condition where there's insufficient blood flow to the intestines, which can cause severe abdominal pain out of proportion to the physical examination findings, along with nausea and vomiting.
  • Ovarian Torsion: Similar to ectopic pregnancy, this is a gynecological emergency that can cause severe, acute abdominal pain, often on one side but can be periumbilical, and requires immediate surgical intervention.