Umbilical endometriosis: A case report

Abstract

Introduction: Cutaneous and umbilical involvement is very rare and represents only 0.5–1% in the various series. Its clinical diagnosis is difficult but it should be suspected in the presence of any bluish, painful umbilical nodule, sometimes with a brownish discharge, the evolution regulated by the menstrual cycle. Ultrasound of the abdominal wall points to the diagnosis of umbilical endometriosis despite the absence of characteristic signs on imaging. Wide surgical excision is the treatment of choice because of its resemblance to a primary tumor or metastasis. Case Report: We report the case of a 31-year-old female patient with no history of abdominal-pelvic surgery or trauma to the umbilicus, consulted for a painful umbilical swelling measuring approximately 1–2 cm diagnosed with umbilical endometriosis. Endometriosis of the umbilical wall is a rare condition, representing only 0.03–2% of extra-genital endometriosis. It is associated with pelvic endometriosis in 26% of cases. Its clinical diagnosis is difficult but it should be suspected in the presence of any bluish, painful umbilical nodule, sometimes with a brownish discharge, the evolution regulated by the menstrual cycle. Ultrasound of the abdominal wall with a high frequency probe is the initial, easily accessible examination that points to the diagnosis of umbilical endometriosis, but it is not pathognomonic. The formal diagnosis of umbilical endometriosis is only obtained with the help of histological examination. The presence of endometrial glands (epithelial cells) and a cytogenic chorion in the ectopic endometrial tissue is necessary to establish the histological diagnosis. In general, medical treatment with danazol, norethisterone, or luteinizing hormone-releasing hormone (LHRH) analogues is recommended before surgery. It would allow a reduction in the size of the endometriotic nodules. Conclusion: Umbilical endometriosis is a very rare form of extra-genital endometriosis. The diagnosis is made when a nodule is present with pain and catamenial bleeding. The diagnosis of certainty is based on a histological study.