Case Report Details Rare Primary Umbilical Endometriosis

Case Report Details Rare Primary Umbilical Endometriosis

In a recent case study published in the Journal of Surgical Case Reports, Carla I.J.M. Theunissen and Frank F.A. IJpma from the Department of Surgery, Isala Clinics in The Netherlands presented the case of a female patient with primary umbilical endometriosis (PUE)

Endometriosis is a common benign disease that is defined by the presence of endometrial tissue outside the uterus that most often affects the pelvic peritoneum.

The presence of endometriosis in the umbilicus rarely occurs. Primary umbilical endometriosis (PUE) is often not recognized based on its clinical appearance, and knowledge about the pathophysiology is scarce.

In the article titled “Primary umbilical endometriosis: a cause of a painful umbilical nodule,” the authors report a rare case of a painful, livid colored nodule in the umbilicus, which turned out to be PUE.

The female patient, aged 47 years, explained that the condition gradually evolved over the course of 6 months. She had no symptoms of dysmenorrhoea or cyclical umbilical pain. At physical examination, she had a soft, painful swelling with a diameter of 2 cm in the umbilicus, which was irreducible by gentle digital pressure.

Results from the Ultrasonography revealed a hypodense nodule of 1.8 cm at the umbilicus. Under the provisional clinical diagnosis, “Irreducible umbilical hernia with probably strangulated fatty tissue in the hernia sac,” surgical exploration of the umbilicus was performed.

Under general anesthesia, a sub-umbilical incision was made, and the doctors found a subcutaneous, lobulated mass, which was fixated on the bottom of the umbilicus. The abdominal wall itself was unaffected. The nodule was excised, and histopathological examination revealed connective tissue fragments with irregular tubular formations surrounded by stromal cells.

The patient was treated by excision of the swelling that turned out to be PUE. Two months after the surgery, she visited the outpatient clinic and reported complete recovery of the painful sensation and swelling in the umbilicus.

The authors indicate the need of increasing the awareness of PUE as a potential diagnose in women with a painful, sometimes discolored umbilical swelling, so this condition can be recognized and treated optimally.

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