Endometriosis also can affect the belly button, according to a new study published in the International Journal of Surgery Case Reports. The authors argue that cases of umbilical endometriosis already are rare, but diagnosis may be complicated further by the presence of umbilical hernias.
The study, “Spontaneous Endometriosis Associated With An Umbilical Hernia: A Case Report And Review Of The Literature,” was initiated by doctors from the University of Texas Health Science Center at Tyler.
Endometriosis is an inflammatory process dependent on estrogen that usually affects organs localized in the pelvic region, including the ovaries, vagina, rectum and bladder. Extrapelvic endometriosis is uncommon, but can occur in almost all organs of the female body, including bowels, lungs, brain and even the umbilicus (belly button).
Indeed, umbilical endometriosis is a rare condition responsible for 0.5 percent cases of extrapelvic endometriosis. Diagnosis of such cases may be very hard to achieve, and is even more difficult when the patient has other health conditions, such as an umbilical hernia, similar to the reported case.
“Umbilical endometriosis occurring in the presence of an underlying hernia is extremely rare and presents a diagnostic challenge for the general surgeon,” the authors wrote.
The physicians reported the case of a 35-year-old woman who complained of cyclic umbilical bleeding for seven months, associated with her menstruation. The bleeding would start two days before her period and last until the end. She reported no umbilical pain, menstruation pain, infertility, or history of endometriosis. She was, however, obese, which masked the presence of an umbilical hernia. The hernia was detected only after doctors ordered a CT scan of her abdomen.
The patient was operated on and underwent primary hernia repair and umbilical reconstruction. Six months after the surgery, the patient remained well and reported no disease recurrence.
Doctors then looked for other similar cases among previously published studies. They found that only seven cases had been reported. In these cases, the median age of the patients was 38 years old and that the time of presentation ranged between two months and five years, which suggests that symptoms are difficult to interpret. In most cases, symptoms were associated with menstruation and all patients also were treated surgically.
“Spontaneous umbilical endometriosis with an underlying hernia is often missed [prior to operation],” the authors concluded. “Preoperative suspicion warrants [imaging techniques] for better operative planning and patient counseling.”