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Man with periumbilical redness and umbilical drainage
  1. Cho Natsuki1,
  2. Taku Harada2,3,
  3. Hiroshige Juichi2
  1. 1 Center of Postgraduate Clinical Training, Showa University Koto Toyosu Hospital, Koto-ku, Tokyo, Japan
  2. 2 General Medicine, Showa University Koto Toyosu Hospital, Koto-ku, Tokyo, Japan
  3. 3 Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
  1. Correspondence to Dr Taku Harada, General medicine, Showa University Koto Toyosu Hospital, Koto-ku, Tokyo 135-8577, Japan; hrdtaku{at}gmail.com

https://doi.org/10.1136/emermed-2020-210944

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    Clinical introduction

    A 42-year-old man presented with periumbilical pain and a draining umbilicus. A day prior to admission, he experienced periumbilical redness and pain. His vital signs were normal. On examination, periumbilical redness, tenderness and a positive Carnett’s sign were observed (figure 1). Despite inflammation (C reactive protein, 2.5 mg/L), laboratory investigations and urinalysis yielded no notable findings. Contrast-enhanced CT was performed. He was prescribed cefaclor.

    Figure 1

    Redness of the periumbilicus.

    Question

    What is the diagnosis?

    1. Diverticulitis

    2. Cellulitis

    3. Metastatic carcinoma

    4. Urachal remnant abscess

    Answer: D

    Contrast-enhanced CT showed an abscess at the umbilical area and a cord-like structure with infiltrated surrounding fatty tissue from the bladder dome to the umbilicus (figure 2). The patient …

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    Footnotes

    • Contributors According to the definition given by the International Committee of Medical Journal Editors (ICMJE), the following individuals qualify for authorship based on their substantial contributions to the manuscript’s intellectual content: TH, conception and design; CN and TH, acquisition of data; CN and TH, patient management and interpretation of data. Furthermore, CN and TH have participated in writing the manuscript. All authors have read and approved the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; internally peer reviewed.