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, due to the buildup of feces in the intestines.
  • Irritable Bowel Syndrome (IBS): Characterized by chronic abdominal pain, bloating, and alteration of bowel habits, which can include periumbilical pain.
  • Peptic Ulcer Disease: Although more commonly associated with epigastric pain, peptic ulcers can sometimes cause pain that radiates or is referred to the periumbilical area.
  • 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 and possibly weight loss.

• Do Not Miss Diagnoses

  • Appendicitis: Although classically presenting with right lower quadrant pain, appendicitis can initially cause periumbilical pain that later migrates. Missing this diagnosis can lead to perforation and severe complications.
  • Intestinal Obstruction: Can cause severe abdominal pain, including around the umbilicus, along with vomiting, constipation, and abdominal distension. Prompt diagnosis is crucial to prevent bowel ischemia and necrosis.
  • Ectopic Pregnancy: In women of childbearing age, ectopic pregnancy can cause lower abdominal pain, which might initially be perceived as periumbilical, along with vaginal bleeding and missed periods. This is a medical emergency.
  • Ovarian Torsion: Another gynecological emergency that can cause severe, sudden-onset lower abdominal pain, which might be referred to the periumbilical area, often accompanied by nausea and vomiting.

• Rare Diagnoses

  • Meckel's Diverticulum: A congenital anomaly of the small intestine that can cause pain, usually in the right lower quadrant but potentially around the umbilicus, along with gastrointestinal bleeding.
  • Mesenteric Ischemia: A condition where there's insufficient blood flow to the intestines, which can cause severe, diffuse abdominal pain, including periumbilical pain, often out of proportion to the physical examination findings.
  • Pancreatitis: While typically causing epigastric pain, pancreatitis can sometimes cause pain that radiates to the back and might be perceived as periumbilical, especially if the pancreatic tail is involved.