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


  • 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


  • Treated by surgical repair or mesh insertion under general anaesthesia

Umbilical hernia


  • 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


  • 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


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


  • 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


  • 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


  • In larger cysts, surgical excision is treatment of choice

Dr Stollery is a GP in Leicestershire

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