{"paper_id":"e60a141c-f7bd-44a6-9411-ba5f08623780","body_text":"Submit Manuscript | http://medcraveonline.com\nIntroduction\nSampson in 1927 described the endometriosis as the presence \nof endometrial glands and stroma outside the uterine cavity and \nformulated the theory of transplantation. There are other 5 theories \nthat try to explain the etiology of the endometriosis.1−3\nIt´s an estrogen-dependent disease that can appear anywhere in \nthe body, most commonly in peritoneum, the ovaries, anterior and \nposterior douglas pounch, posterior broad ligaments, uterosacral \nligaments, fallopian tubes, sigmoid colon, appendix and round \nligaments, less common in lungs, thorax, brain and pericardium. In \nwomen with previous C-section, umbilical endometriosis can occur \nin 30% of cases.1−5 \nEndometriosis is a common nonmalignant cause of dysmenorrhea, \ndyspareunia, chronic pain, and infertility. The diagnosis based in \nsymptoms is difficult; it can vary from complete absence of symptoms \nto disabling pelvic pain during the menstrual period and infertility. \nThe prevalence depends if women are asymptomatic (1-7%), or \nsymptomatic that is much higher and variable (70% in women and \nadolescents with pelvic pain, 50% in infertile women and 40% of \nadolescents with genital tract anomalies).2,3,5\nCase report \nAfrican female patient, 33 years old, clinical antecedents \nunremarkable, G0P0A0, dysmenorrhea and methroragy since \nmenarche at age 14 years old.\nShe was admitted in Emergency Room with an abdominal pain. \nShe referred an umbilicus tumor, which appeared 6 months ago. It has \nbecome bigger during menstrual period, with abdominal tenderness. \nThe pain was relieved with oral analgesic (Tramadol) (Figure 1).\nIn objective exam, she had a tender umbilical tumor with 2cm. In \nthe ultrasound the tumor had imaging features of an umbilical abscess. \nThe surgeon tried to drainage it but was unsuccessful. \nFourteen days after she was observed in another hospital. The \nobservation in general surgery appointment was overlapping. \nThe surgeon recommended removal of the umbilical tumor and \nscheduled the surgery. The procedure was performed 7 days after \nand was removed a tumor with 20×20mm. The histology revealed an \nendometriosis lesion. \nFigure 1 Umbilicus endometriosis.\nShe was forwarded for gynecologic department. In gynecologic \nevaluation it was found absent of uterine mobility, retroverted uterus, \nand uterine motion tenderness in pelvic examination. The douglas \npounch was tender and a mass filling it. \nPelvic Ultrasound showed cists in the both ovaries and a kissing \novaries. In pelvic MRI was observed deep endometriosis in posterior \nslope of the right ovary, in Douglas pounch and in both utero sacral \nligaments. It was observed many fibromas, the largest of which is in \nthe posterior portion of the uterine body with a maximum diameter of \n23mm. Ca 125 was 51.7U/mL\nFour months later, the patient was undergone a laparoscopic surgery \nfor endometriosis. It was found deep endometriosis in utero sacral \nligaments (bilateral), in rectovaginal septum and in left ureter. Both \novaries had endometriotic cists. The uterus had multiples fibroids. \nThe excision of the lesions of endometriosis in utero sacral ligaments \nand rectovaginal septum was performed. The endometrioma of both \novaries were removed. Ureteriolysis was done in left side. Some \nfibroids were removed. \nObstet Gynecol Int J. 2018;9(5):326‒327. 326\n© 2018 Adolfo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which \npermits unrestricted use, distribution, and build upon your work non-commercially.\nUmbilical endometriosis in a patient without \nabdominal surgery\nVolume 9 Issue 5 - 2018\nDarlene Adolfo,1 Pedro Brandão,2 Paula \nRamôa,3 Amelia Almeida4\n1Department of Interne Medicine, Hospital Sousa Martins, \nPortugal \n2Department of Gynecologic/Obstetric, Centro Hospitalar \nTâmega e Sousa, Portugal \n3Department of Gynecologic/Obstetric, Hospital Lusíadas, \nPortugal \n4Department of Gynecologic/Obstetric, Centro Hospitalar \nMédio Ave, Portugal \nCorrespondence: Darlene Adolfo, Department of Interne \nMedicine, Hospital Sousa Martins, Guarda, Portugal, T el \n0035964598114, Email darlene2@lior.com.pt\n \nReceived: July 30, 2018 | Published: September 18, 2018\nAbstract\nEndometriosis is the presence of endometrial glands and stroma outside the uterine cavity. \nIt is an estrogen-dependent disease. Can appear anywhere in the body, most commonly in \nthe ovaries, anterior and posterior douglas pounch, posterior broad ligaments, uterosacral \nligaments, fallopian tubes, sigmoid colon, appendix and round ligaments. In women with \nprevious C-section, umbilical endometriosis can occur in 30% of cases. It is a common \nnonmalignant cause of dysmenorrhea, dyspareunia, chronic pain, and infertility. The \nsymptoms depend on the implantation of the ectopic stroma. The prevalence depends if \nwomen are asymptomatic (1-7%), or symptomatic that is much higher and variable (70% in \nwomen and adolescents with pelvic pain, 50% in infertile women and 40% of adolescents \nwith genital tract anomalies). \nKeywords: umbilical endometriosis, abdominal pain\nObstetrics & Gynecology International Journal\nCase Report\n Open Access\n\n\nUmbilical endometriosis in a patient without abdominal surgery\n327\nCopyright:\n©2018 Adolfo et al.\nCitation: Adolfo D, Brandão P , Ramôa P , et al. Umbilical endometriosis in a patient without abdominal surgery. Obstet Gynecol Int J. 2018;9(5):326‒327. \nDOI: 10.15406/ogij.2018.09.00357\nShe was discharged the hospital after 5 days, medicated with \nDesogestrel 75 mycrograms. The patient was asymptomatic almost \nall the time. \nAfter 14 months, she realized another pelvic MR that revealed \nendometriosis in abdominal subcutaneous tissue. Presence of \ndeep endometriosis in the Douglas pounch with 8mm and in the \nposterior vaginal wall with 5mm. The right ovary had presence of an \nendometrioma 11*3mm and another endometrioma in the left ovary \nhave 18mm. Two uterine fibroids persist. \nDiscussion\nEndometriosis is a complex and mysterious disease for women and \nrelatives. It is considered one of the mainly causes of gynecological \nhospitalization and approximately 30%-50% of women with the \ndisease can develop infertility.3\nAccording to the bibliography, cutaneous endometriosis represents \n1% of all ectopic endometrium. It´s classified as primary, without \nhistory of surgery, the pathogenesis is unknown. Secondary related \nmostly to a prior surgical scar tissue after abdominal operations \n– iatrogenic implantation of endometrial cells. Primary umbilical \nendometriosis is a rare entity, represents only 0.4% to 4.0% of all \nendometriosis.1,2,6\nBibliography refers that black race can be a protective factor with \nhigher prevalence in Caucasians and Asian women.7\nThe natural history of the patient takes to the suspicion of diagnosis, \nmany women from the onset of symptoms to the diagnosis take about \n6 years. MRI is the key exam to determine the presence or extent of \nendometriosis (the experience of the Radiologist with the diseases is \nimportant, because it will determine the posture of the surgeon for the \noperatory moment). Serum CA-125 is a noninvasive marker, to the \ndisease in high stages. However the gold standard continues to be the \nlaparoscopic surgery with histologic confirmation.1,4,5,8\nThe treatment for pain can be medical: empirical analgesics, \nhormonal contraceptives progestogens, anti-progestagens, GnRH \nagonists and aromatase inhibitors – stop the evolution of endometriosis \nand symptoms. The surgery is an option when medical treatment fails \nor in some anatomic location of disease.1,4,9−11\nConclusion\nWith this case report the authors highlight the difficult of deep \nendometriosis diagnosis in absence of suspicion. In our case report \nthe diagnosis only was made after histologic exam of endometriosis \nin umbilical tumor. Endometriosis continues to be an unknown \npathology outside gynecologic community. \nAcknowledgments\nNone. \nConflicts of interest\nAuthors did not report any potential conflicts of interests.\nReferences\n1. Sterling RK, Wright EC, Morgan TR, et al. 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World J Surg Oncol. 2017;15(1):122–128.","source_license":"CC0","license_restricted":false}