Differential Diagnosis for Stomach Pain and Induration near Umbilicus after Gallbladder Removal

Single Most Likely Diagnosis

• Adhesions or Internal Hernia: Given the patient's recent history of gallbladder removal (cholecystectomy) 2 months ago, adhesions or an internal hernia could be causing the stomach pain and the induration near the umbilicus seen on the CT scan. Adhesions are bands of fibrous tissue that can form between organs or between an organ and the abdominal wall after surgery, potentially causing bowel obstruction or pain. An internal hernia, where part of the intestine bulges through a defect in the peritoneal cavity, is another possibility.

Other Likely Diagnoses

• Incisional Hernia: This is a type of hernia that can occur through a scar or incision in the abdominal wall, which could be related to the recent surgery. The induration near the umbilicus could be indicative of a hernia, especially if the gallbladder was removed through an open incision rather than laparoscopically.
• Bowel Obstruction: Partial or complete blockage of the bowel can cause severe abdominal pain and could be related to adhesions from the surgery. The induration might be related to the site of obstruction.
• Infection or Abscess: Although less likely given the time frame since surgery, an infection or abscess near the surgical site could cause localized induration and pain.

Do Not Miss Diagnoses

• Bowel Ischemia or Infarction: This is a serious condition where the blood supply to part of the bowel is compromised, which could be due to an embolus, thrombosis, or venous thrombosis. It's crucial to diagnose promptly as it can lead to severe consequences, including death.
• Perforated Viscus: A hole in the wall of the stomach or intestine can lead to peritonitis, an infection of the abdominal cavity, which is life-threatening. The induration could be a sign of localized peritonitis.

Rare Diagnoses

• Desmoid Tumor: A rare type of tumor that can occur in the abdominal wall, potentially causing a palpable mass or induration. These tumors are more common in patients with a history of familial adenomatous polyposis (FAP) but can occur sporadically.
• Abdominal Wall Endometriosis: In females, endometrial tissue can implant in the abdominal wall, including near surgical scars, leading to cyclical pain and a palpable mass. This condition is rare but should be considered in the differential diagnosis of abdominal wall masses in women.

Each of these diagnoses should be considered and investigated based on the patient's specific symptoms, history, and findings on the CT scan. Further diagnostic tests, such as an MRI or a surgical consultation, may be necessary to determine the cause of the induration and stomach pain.