Algorithmic Assessment of an Umbilical Bulge

Algorithmic Assessment of an Umbilical Bulge

by Reynaldo O Josonon Sunday, April 29, 2012 at 10:47pm ·

Here is my recommended algorithmic assessment of a patient with an umbilical bulge.

 

 

Check first if the bulge is a hernia or not.  A reliable sign that it is a hernia is that it is reducible, meaning it goes inside the abdominal cavity as it is pressed inward and it bulges again upon release of the pressing or if the patient is asked to cough to increase the intraabdominal pressure.

 

Umbilical hernia

 

Umbilical hernia

 

If it is not a hernia, determine if it is a mass or just an induration or thickening.

 

If it is a mass, determine if it is malignant (cancerous) or not.  Look for history and signs of malignancy outside and on the umbilicus. (to be expounded in the future)

 

A cancer in/on the umbilicus may be primary or metastatic (coming from elsewhere).   A primary cancer may arise from the skin and soft tissue of the umbilicus.

 

If the umbilical mass is not cancer, determine if it is inflammatory or non-inflammatory.  Look for signs of inflammation like pus and redness.  An abscess is an example of an inflammatory umbilical mass.  Examples of non-inflammatory masses include an umbilical granuloma, fibroepithelial polyp, and endometrioma or endometriosis externa.  If the non-inflammatory non-malignant umbilical mass is enlarging and becoming more painful during mense, an endometrioma or endometriosis externa should be considered.

 

Umbilical mass, benign, fibroepithelial polyp in a 40-year-old female

 

Umbilical mass, benign, fibroepithelial polyp in a 40-year-old female

 

Umbilical mass, benign, fibroepithelial polyp, after removal

 

Umbilical mass, benign, fibroepithelial polyp, on cut-section of the polyp

 

Umbilical endometriosis with history of enlargement and pain during mense

 

Umbilical endometriosis, after removal, showing a mense area, the reddish part

 

In the future, I will add illustrative pictures of other diseases of the umbilicus.

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