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TWISTING OF THE UMBILICUS IS IT A REAL SYMPTOM OR SIGN ?

OP
Kapoor
Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

All these years in my practice I have heard patients complaining that they used to get an attack of twisting of the umbilicus. These attacks cause severe abdominal pain. This was set right by women who were specialised in the job of massaging the abdomen and setting the umbilicus back to its right place.

The umbilicus which is known in the local language as either 'rug' or 'pichoti' or 'naabi' or 'dhunni' has been neglected in the medical books, though some diseases of the umbilicus have been described e.g. chronic umbilical discharge, umbilical sepsis in the new born leading to portal hypertension, umbilical hernia, etc. The umbilicus has been given more importance in the last few years by the film folks and others by showing close up pictures of the umbilicus when the women are dancing, more as a sex symbol!

It happened that in my practice I had a patient on the examination table who told me that he was at that moment having an attack of "twisting of the umbilicus". When I looked at the umbilicus, it looked normal to me. When I asked the patient why do you think that it is twisted, he raised his head from the supine position to show me his umbilicus. Thus the flexion of his head shifted the umbilicus which he pointed out as abnormal!!

The umbilicus can change the shape e.g. it becomes transverse in patients having ascites. But that shape remains same in the supine position and is not brought out by flexing the head.

In my opinion, all these attacks of abdominal cramps which are attributed to the twisting of the umbilicus are due to spasm of the transverse colon and occur in patients having irritable bowel syndrome. Thus, although an IV injection of baralgan or any similar injection can relieve this attack immediately, simple measures like putting hot water bag on the tummy and doing light massage to the transverse colon (which is at the level of the umbilicus) will relieve most of these spasms. If there was any organic surgical cause, these patients would have certainly landed up for surgery one day (which does not occur)!

In my opinion, the above symptom which is commonly mentioned by people in all the Indian villages and towns and more common in communities like Gujratis and Maharashtrians, really does not exist.



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