Possible Causes for periumbilical pain Umbilical Hernia We report a case of a painful periumbilical mass ultimately diagnosed as an infected urachal cyst. [ncbi.nlm.nih.gov] They are often initially mistaken for more common causes of lower abdominal pain, and the diagnosis is usually made during evaluation for one of these more common conditions [ncbi.nlm.nih.gov] Appendicitis It typically presents with periumbilical pain, which migrates to the right lower quadrant (RLQ), associated with fever, vomiting, anorexia, and malaise. [amboss.com] Snap Shot 24-year-old presents with nausea, vomiting, constipation, and periumbilical pain that settles in the lower right quadrant. [step2.medbullets.com] Symptoms and Signs The classic acute appendicitis symptoms are Epigastric or periumbilical pain followed by brief nausea, vomiting, and anorexia After a few hours, the pain [merck.com] Intestinal Obstruction Clinical features Periumbilical pain that is disproportionate to physical findings Nausea and vomiting Diarrhea (bloody in later stages) Gangrenous bowel: rectal bleeding [amboss.com] Condition Presentation Diagnosis Management Appendicitis[14] Abdominal pain, nausea, vomiting, fever Periumbilical pain, migrates to RLQ Clinical (history & physical exam) [en.wikipedia.org] Evaluate pain. Crampy abdominal pain, an early sign, may be centered in the periumbilical area. [nurses.com] Small Bowel Obstruction Condition Presentation Diagnosis Management Appendicitis[14] Abdominal pain, nausea, vomiting, fever Periumbilical pain, migrates to RLQ Clinical (history & physical exam) [en.wikipedia.org] Evaluate pain. Crampy abdominal pain, an early sign, may be centered in the periumbilical area. [nurses.com] Colicky, periumbilical Colicky or constant Vomiting/nausea Early-onset Large volume Bilious Late-onset Initially bilious Progresses to fecal vomiting (presence of feces in [amboss.com] Pancreatic Abscess The sequence is typical: periumbilical or epigastric reference of pain at onset, followed by a shift to the right lower quadrant after a few hours. [atsu.edu] Pain is the principal and often the only symptom of uncomplicated appendicitis. [atsu.edu] Acute Pancreatitis […] in the left upper quadrant, periumbilical region, and/or epigastrium, although in some cases acute pancreatitis may be painless. [aafp.org] Initially, the pain worsens after eating or drinking, especially fatty foods, and then typically becomes constant over time. [aafp.org] Pancreatic cancer Perforated peptic ulcer Tubo-ovarian abscess HISTORY AND PHYSICAL EXAMINATION Patients with pancreatitis commonly present with sudden onset of abdominal pain [aafp.org] Acute Mesenteric Ischemia We present the case of an 84-year-old woman who presented to our emergency department complaining of an acute worsening of pre-existing abdominal periumbilical pain, nausea [ncbi.nlm.nih.gov] Clinical presentation is classically that of acute onset of severe periumbilical pain that is out of proportion to physical exam findings, /- nausea/vomiting. [errolozdalga.com] His abdominal pain evolved to a periumbilical “jabbing” pain exacerbated by movement and palpation. [acgcasereports.gi.org] Umbilical Sepsis He suffered from periumbilical pain for about 1 week. The character of the pain was not cramping but persistent. [ajemjournal.com] Constant periumbilical pain with or without foul-smelling umbilical discharge may be the initial presentation as our case. [ajemjournal.com] In summary, omphalitis/urachal abscess may only present as abdominal pain without obvious erythematous periumbilical tissue or exudates in adults. [ajemjournal.com] Embolic Mesenteric Infarction Clinical presentation is classically that of acute onset of severe periumbilical pain that is out of proportion to physical exam findings, /- nausea/vomiting. [errolozdalga.com] In the evening on the same day, he complained of acute and persistent periumbilical pain without abdominal distension. [e-jnc.org] His abdominal pain evolved to a periumbilical “jabbing” pain exacerbated by movement and palpation. [acgcasereports.gi.org] Retrocecal Appendicitis RESULTS: Patients presented with right lower abdominal pain (49%, 16/33), right flank pain (24%, 8/33), right upper abdominal pain (18%, 6/33), and periumbilical pain (15% [ncbi.nlm.nih.gov] Thirty-six percent of the patients had the classic appendicitis scenario of periumbilical pain localizing to the right lower quadrant, accompanied by anorexia, nausea and [ncbi.nlm.nih.gov] It typically presents with periumbilical pain, which migrates to the right lower quadrant (RLQ), associated with fever, vomiting, anorexia, and malaise. [amboss.com] Mesenteric Infarction The most common is the 10—30 minutes postprandial occurring dull abdominal pain. It is periumbilically localized and lasts for one to four hours. [lecturio.com] Clinical presentation is classically that of acute onset of severe periumbilical pain that is out of proportion to physical exam findings, /- nausea/vomiting. [errolozdalga.com] Clinical features Periumbilical pain that is disproportionate to physical findings Nausea and vomiting Diarrhea (bloody in later stages) Gangrenous bowel: rectal bleeding [amboss.com] Ventral Hernia Laparoscopic ventral hernia repair is an operation associated with significant postoperative pain, and regional anaesthetic techniques are of potential benefit. The erector spinae plane (ESP) block performed at the level of the T5 transverse process has recently been described for thoracic surgery, and we[…] [ncbi.nlm.nih.gov] Mesenteric Vein Thrombosis A 76-year-old Caucasian man presented with acute onset of intense periumbilical abdominal pain associated with nonbloody diarrhea. [accesssurgery.mhmedical.com] […] and lower abdominal pain for 1 week. [mdedge.com] […] patients with MVT. 1 Peritoneal signs and bloody stools portend poor outcomes, as they often occur with disease progression. 4 Case A 26-year-old man presented to the ED with periumbilical [mdedge.com] Epigastric Hernia Epigastric hernia Abdominal ultrasound of a midline epigastric hernia. Specialty General surgery An epigastric hernia is a type of hernia that causes fat to push through a weakened area in the walls of the abdomen. It may develop in the epigastrium (upper, central part of the abdomen). Epigastric hernias are more[…] [en.wikipedia.org] Omphalitis A significant decrease in periumbilical pain, elimination of the disturbing chronic discharge, and vaporization of the reactive granulation tissue were achieved, suggesting [ncbi.nlm.nih.gov] Chronic Pancreatitis Pancreaticopericardial fistula (PPF) is an extremely rare clinical problem encountered in patients with chronic pancreatitis. The diagnosis should be suspected if a patient presents with pericardial effusion on a background of chronic pancreatitis. Significantly raised amylase in the pericardial fluid offers an[…] [ncbi.nlm.nih.gov] Abdominal Angina Location epigastric pain can come from the stomach, duodenum, or pancreas. right upper quadrant pain can come from the biliary tree or liver (cholecystitis) periumbilical [sharinginhealth.ca] Although evidence of arteriosclerosis elsewhere and a short early systolic bruit may be audible in the periumbilical region, it is frequently absent. [omicsonline.org] pain can come from the small intestine, appendix, or colon. sacral pain can come from the rectum. hypogastric pain can come from the colon, bladder, or uterus. [sharinginhealth.ca] Viral Gastroenteritis BACKGROUND: Viral gastroenteritis is common, especially in young children. In adults, particularly amongst the elderly, it can lead to outbreaks at a time when demands on clinical services are at their peak. AIM: To evaluate seasonal screening of young children and elderly patients with suspected viral gastroenteritis[…] [ncbi.nlm.nih.gov] Pancreatic Phlegmon Sx of pancreatitis: Epigastric or periumbilical pain, often radiates to the back as well as to the cheest, flanks, & lower abd. [enotes.tripod.com] The pain is relieved by sitting forwards. The pain is accompanied by nausea and vomiting. [histocutup.co.uk] The clinical presentation of acute pancreatitis is usually left upper-quadrant pain or midepigastric pain with radiation to the back. [dummies.com] Intestinal Perforation Several recent reports have suggested that, in select premature neonates, intestinal perforation may be managed by peritoneal drainage alone. Much like a surgical Graham patch, the omentum may seal an intestinal perforation allowing healing while maintaining bowel continuity. This photograph, illustrating a classic case[…] [ncbi.nlm.nih.gov] Pancreatic Pseudocyst A 56 years old man presented with epigastric pain and abdominal distension. He suffered an attack of acute pancreatitis 6 weeks back followed by pseudopancreatic cyst formation. As the cyst kept on enlarging in size despite being on conservative management, the patient was operated after 5 weeks. A huge[…] [ncbi.nlm.nih.gov] Meckel Diverticulitis The most common initial presentation is a periumbilical, gnawing pain that migrates within a few hours to the right iliac fossa. [surgwiki.com] periumbilical tenderness and intermittent crampy abdominal pain. Perforation of the inflamed diverticulum can result in peritonitis. [en.wikipedia.org] […] acute abdominal pain Can result in perforation Enteroliths ( 10%) Neoplasia ( 3%) Most often carcinoid (M F) Imaging Findings Abdominal Film, non-specific: Enteroliths, small [learningradiology.com] Acute Hepatic Porphyria Alnylam presented results from their phase 3 ENVISION trial, which assessed givosiran for acute hepatic porphyria (AHP), at the European Association for the Study of the Liver (EASL) International Liver Congress in Vienna, Austria. ENVISION was a randomized, double-blind, placebo-controlled, global, multicenter study[…] [trialsitenews.com] Meckel Diverticulum Localised periumbilical pain may be experienced in the right lower quadrant (like appendicitis). [en.wikipedia.org] Keller, M.D. 1 Citing Article A 10-year-old boy presented to the emergency department with increasing periumbilical and epigastric pain after a 3-week period of intermittent [nejm.org] Diverticulitis Symptoms include diarrhoea, abdominal cramps and periumbilical tenderness. [patient.info] Littre Hernia pain Recurrent episodes of intestinal obstruction Physical examination May reveal palpable mass of herniated bowel loops with localized tenderness Diagnostic studies [learningradiology.com] […] their natural place in a cavity Autopsy incidence May remain clinically silent if easily reducible Larger ones symptomatic Vague epigastric discomfort Colicky periumbilical [learningradiology.com] Acute Intermittent Porphyria Acute intermittent porphyria (AIP) is the most common hepatic porphyria. Its clinical presentation includes severe disabling and life-threatening neurovisceral symptoms and acute psychiatric symptoms. These symptoms result from the overproduction and accumulation of porphyrin precursors, 5-aminoleuvulinic acid (ALA)[…] [ncbi.nlm.nih.gov] Pneumoperitoneum Abstract Pneumoperitoneum following blunt abdominal trauma in the absence of other signs of severe intraabdominal injury is a rare finding. Although the vast majority of all cases of pneumoperitoneum are due to a ruptured intraabdominal hollow viscus, free abdominal air may result from significant barotrauma to the[…] [ncbi.nlm.nih.gov] Mesenteric Cyst Mesenteric cysts are rare intraabdominal lesions of childhood that may vary in presentation from an asymptomatic mass to an acute abdomen. We encountered a rare case of peritonitis caused by a ruptured, infected mesenteric cyst of the mesocolon in a female child that had been initially interpreted as a ruptured[…] [ncbi.nlm.nih.gov] Hemoperitoneum Surg Clin North Am. 2014 Feb;94(1):65-9. doi: 10.1016/j.suc.2013.10.006. Epub 2013 Oct 30. Author information 1 Section of Trauma & Acute Care Surgery, Boston Medical Center, Boston University School of Medicine, 840 Harrison Avenue, Dowling 2 South, #2414, Boston, MA 02118, USA. Electronic address: gkasot@bu.edu.[…] [ncbi.nlm.nih.gov] Abdominal Muscle Strain […] by Steve Hole, MD 2012 Though he’s under a 2-year, 15 million contract with the World Series champion San Francisco Giants, Brian Wilson wears several hats: tattoo canvas, captivating interview star, and closer extraordinaire. The relief pitcher led the majors with 48 saves in 2010 and pitched his best in the biggest[…] [myhousecallmd.com]
