The painful black umbilicus

Abstract

We want to report an interesting case of a 38-year-old woman, para 2 live 2, who presented to the outpatient clinic with a complaint of a painful black umbilicus for eighteen months. There was no history of any surgery on the abdomen. Her menstrual cycles were regular with average flow and mild dysmenorrhea only. Her last childbirth was nine months back. She had taken anti-tubercular treatment for tuberculosis of the intestine in 2008 for nine months. There was no other significant past medical/surgical or family history. On abdominal examination there was a dark brownish nodule replacing whole of the umbilicus. It was fixed to the underlying skin and was minimally tender. Speculum and vaginal examinations revealed a healthy looking cervix and vagina and a multiparous-size mobile uterus. Fine needle aspiration cytology (FNAC) from the nodule suggested endometriosis. The patient underwent excision of the endometriotic nodule with umbilical reconstruction under general anesthesia, and was discharged the same evening. Histopathology confirmed umbilical endometriosis. Pre-operative and post-operative pictures and the specimen are shown in Fig. 1. The patient is symptom-free at one year follow-up.