Primary Umbilical Endometriosis: A Case Report and Literature Review

Introduction: Endometriosis is a disease condition characterized by the presence of endometrial glands and stroma outside the uterine cavity and musculature. It affects 7– 10% of women of 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. Case Presentation: A 32-year-old Para II mother presented with umbilical swelling and pain that worsened during the menses of 2 months. She had two caesarean scars, both transverse Pfannenstein incisions. There was a dark blue, firm to hard 2× 3 cm umbilical mass on physical examination. Laboratory results are normal. Ultrasound of the abdomen showed umbilical mass with homogeneous echotexture measuring 2 cm × 3 cm with an irregular border and hypoechoic texture. An excisional biopsy was performed and a biopsy showed umbilical endometriosis. 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– 1%. 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 bleeds concomitantly with the menstrual cycle. Ultrasound and other imaging techniques help in making diagnoses, and the diagnosis is confirmed by cytological examination. The management of umbilical endometriosis involves 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 an umbilical lesion that becomes more painful and swollen during her menstrual period. Appropriate clinical examination and workup are helpful to make a diagnosis and do a surgical excision. Keywords: endometriosis, umbilical nodules, umbilical hernia, abdominal wall scar, caesareans section