Spontaneous umbilical endometriosis: Rare occurrence in nulliparous women - Case report & literature review

Abstract

Introduction and importanceEndometriosis is an inflammatory disease associated with pelvic pain and infertility that is characterized by lesions of endometrial-like tissue outside of the uterus. It affects roughly 10 % of reproductive age women and girls globally. Umbilical endometriosis is a rare pathology accounting for 0.5 to 1 % of all extra-pelvic endometriosis. Due to the varied presentations and rare incidence of endometriosis, it remains a diagnostic dilemma and challenge to treat it timely and properly. Case presentationA 32-year-old nulliparous lady who presented with umbilical lump, cyclical pain, and bleeding during menstrual cycle without any prior history of abdominal surgery of a year duration. Ultrasound and magnetic resonance imaging support the diagnosis of umbilical endometriosis and ruled out multifocal involvement. She was managed with surgical excision with free margin followed by umbilical reconstruction and the diagnosis was confirmed by biopsy. DiscussionUmbilical endometriosis could be either secondary to endometrial tissue implantation during laparoscopic or open surgical procedures also called scar endometriosis or as a primary umbilical endometriosis with no previous surgery. The characteristic presentation for umbilical endometriosis is a brown to dark nodule in the umbilicus, which may be swollen, painful, and sometimes bleed during menstrual periods. ConclusionUmbilical endometriosis is a rare condition that should be considered as a differential diagnosis in women with umbilical lump, cyclical pain, and bleeding. The diagnosis is clinical and confirmed by histopathology. Surgical excision is the treatment of choice with a low risk of recurrence or malignancy.