Primary Umbilical Endometriosis. A Case Report and Literature Review

Introduction: Endometriosis a disease condition characterized by the presence of endometrial glands and stroma outside the uterine cavity and musculature. It affects up to 7-10% of women in their reproductive age and usually involves pelvic organs. The common symptoms include dysmenorrhea, menorrhagia, pelvic pain, dyspareunia and infertility. Umbilical endometriosis is the rarest form of extra pelvic endometriosis. Secondary umbilical endometriosis occurs after abdominal procedures while primary umbilical endometriosis develops without previous procedures and the cause is barely known. Metaplasia of urachal remnant is possible explanation of primary umbilical endometriosis. Case Presentation: A 32years old para two mother presented with umbilical swelling and pain which worsens during menses of 2 months. She had 2 cesarean scar both transverse pfannenstein incision. There was dark blue firm to hard 2x3cm umbilical mass on physical examination. CBC and OFTs results are normal. Ultrasound of the abdomen showed umbilical mass with homogeneous echotexture measuring 2 cm × 3 cm with irregular border and hypoechoic texture. FNAC suggested a diagnosis of umbilical endometriosis. The case was jointly discussed with obstetrics and gynecology side. After decision to excise the mas was made informed written consent was taken and the patient was taken to Operation Theater the mass was excised enblock with surrounding tissue and underlying fascia. The umbilicus was reconstructed. The specimen was sent for biopsy and the result confirmed the diagnosis. Discussion: Primary umbilical endometriosis is a disorder first described by Villar in 1886 and among all cases of extra genital involvement of endometriosis primary umbilical endometriosis accounts for 0.5 t0 1%. The commonest site of extra-genital endometriosis is the pelvic organs which present with pelvic pain. The usual presentation of primary umbilical endometriosis is typically the presence of a discrete bluish-purple mass in the umbilicus which becomes swollen, painful, and bleed concomitantly with the menstrual cycle. Ultrasound and other imaging techniques help in making a diagnosis and the diagnosis is confirmed by cytological examination. The management of umbilical endometriosis is surgical excision and reconstruction of the umbilicus. Conclusion: umbilical endometriosis is an uncommon form of extra pelvic endometriosis. There is a wide differential diagnosis for swellings of the abdominal wall, however, it should be suspected in any female patient of reproductive age with umbilical lesions, which become more painful and swollen during her menstrual period. Appropriate clinical examination and work up are helpful to make a diagnosis and do surgical excision. In addition, attention should be given to ruling out the coexistence of pelvic endometriosis and infertility.