Chills and Burning Sensation in the Belly Button
The most likely causes are umbilical infection (omphalitis), umbilical hernia with possible incarceration, or less commonly an omphalomesenteric duct remnant, and you should immediately examine for periumbilical erythema, warmth, discharge, or a palpable mass to guide urgent management.
Immediate Assessment
Examine the umbilicus directly for:
- Erythema, warmth, swelling, or purulent discharge suggesting infection 1
- A palpable bulge or mass indicating umbilical hernia 2
- Tenderness with or without rebound, which may indicate peritonitis 1
- Any umbilical deformity or abnormal appearance 3
Check for systemic signs of infection:
- Fever or hypothermia (temperature >38°C or <36°C) 1
- Chills are a cardinal sign of bacterial infection and should prompt immediate workup 1
- Tachycardia, hypotension, or altered mental status suggesting sepsis 1
Diagnostic Workup
Obtain laboratory studies immediately if infection is suspected:
- Complete blood count with differential to assess for leukocytosis 1
- Blood cultures if fever and chills are present 1
- C-reactive protein (CRP) and proctocalcitonin (PCT) in critically ill patients to evaluate severity of inflammation 1
Imaging should be obtained urgently:
- Abdominal ultrasound as first-line to evaluate for umbilical hernia, fluid collections, or abscess 1
- CT scan if ultrasound is inconclusive or if there is concern for intra-abdominal pathology 1
Common Causes and Management
Umbilical Infection (Omphalitis)
The burning sensation combined with chills strongly suggests bacterial infection. Initiate empirical antibiotics immediately after obtaining cultures if there are signs of systemic infection, as mortality increases by 10% for every hour's delay in patients with sepsis 1.
Umbilical Hernia with Complications
Umbilical hernias can contain omentum, bowel, or rarely the appendix 2. If a hernia is palpable with acute pain and systemic symptoms, suspect incarceration or strangulation requiring urgent surgical evaluation 2. The burning sensation may represent peritoneal irritation from compromised hernia contents.
Omphalomesenteric Duct Remnant
Though less common, this congenital anomaly can cause episodic abdominal pain and may present with umbilical deformity 3. Consider this diagnosis if there is a history of recurrent unexplained periumbilical pain or an unusual umbilical appearance 3.
Functional Causes (Less Likely with Chills)
Burning sensations in the abdomen can occur with functional disorders 1, 4, but the presence of chills makes infection or structural pathology far more likely and requires exclusion of serious causes first 1.
Critical Actions
Do not delay treatment if infection is suspected:
- Start broad-spectrum antibiotics immediately after cultures if sepsis is present 1
- Ensure adequate fluid resuscitation 1
- Arrange urgent surgical consultation if hernia incarceration or abscess is identified 2
Common pitfall: Dismissing periumbilical symptoms as benign without proper examination. The umbilicus can harbor serious pathology including hernias with incarcerated contents (including appendicitis) 2 and infections that can rapidly progress to sepsis 1.