Differential diagnoses: Abdominal swellings

Four presentations of abdominal swellings, including paraumbilical hernia, umbilical hernia, umbilical granuloma and ovarian cysts, and advice on their management.

Paraumbilical hernia

Presentation

  • Defect in abdominal musculature adjacent to umbilicus
  • Acquired, as opposed to umbilical hernia, which may be congenital
  • Usually enlarges with time if untreated and may strangulate
  • May reduce on lying down and recur on standing
  • Usually painless, unless large or strangulated
  • Exacerbating factors include obesity, lifting, straining, ascites, COPD and coughing
  • May be a familial predisposition

Management

  • Treated by surgical repair or mesh insertion under general anaesthesia

Umbilical hernia

Presentation

  • May be congenital or acquired
  • Occurs because of defect at site of umbilicus
  • Acquired umbilical hernia is three times more common in women than in men
  • Risk factors include obesity, lifting, coughing and multiple pregnancies
  • Usually painless swelling

Management

  • Congenital hernias usually resolve by age of two or three years
  • If not, can be treated surgically at five or six years old
  • Large acquired hernias can be treated by direct closure or mesh

Umbilical granuloma

Presentation

  • Occurs in neonatal period after separation of umbilical cord
  • Friable, moist surface, which may discharge clear fluid
  • Secondary infection may occur, producing an odour

Management

  • Usually heal without treatment
  • If treatment is required, topical silver nitrate can be used, under the guidance of a healthcare professional
  • If secondary infection present, may require topical antibiotics

Ovarian cyst

Presentation

  • Rare cause of abdominal swelling, which may look like term pregnancy
  • Usually gradually increases in size over a period of months
  • When very large, as in this case, can affect eating, causing bloating and weight loss
  • May be benign or malignant
  • No variation in size with position
  • Ultrasound scan can aid diagnosis

Management

  • In larger cysts, surgical excision is treatment of choice

Dr Stollery is a GP in Leicestershire

Take a test on this article and claim your certificate on MIMS Learning

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Before commenting please read our rules for commenting on articles.

If you see a comment you find offensive, you can flag it as inappropriate. In the top right-hand corner of an individual comment, you will see 'flag as inappropriate'. Clicking this prompts us to review the comment. For further information see our rules for commenting on articles.

comments powered by Disqus
Follow Us: