861 A Case of Secondary Cutaneous Endometriosis with a Paraumbilical Hernia

Abstract Introduction Endometriosis, a chronic benign condition affecting reproductive-age women, is rarely seen in extra-pelvic locations, with umbilical cutaneous endometriosis being particularly uncommon. This report details a diagnostic challenge involving cutaneous endometriosis associated with a paraumbilical hernia (PUH). Case Report A 42-year-old woman presented with a six-month history of a slowly enlarging, occasionally painful umbilical lump, with no gynecological symptoms or menstrual correlation. Physical examination revealed a cough impulse and sub-centimeter non-tender skin nodules in the umbilical region. Ultrasound confirmed a 2.1 cm abdominal wall defect with hernial sac containing omental fat. The patient underwent primary hernia repair, excision of the subcutaneous nodules, and umbilical reconstruction. Intraoperatively, the hernial sac was tightly adhered to the umbilical skin and contained additional subcutaneous nodules. The sac and umbilical skin were excised, and the defect repaired with a polypropylene mesh. Histology confirmed endometriosis in both the sac and umbilical skin. The patient recovered without complications and was referred for gynecological evaluation, which ruled out pelvic endometriosis. Discussion Cutaneous endometriosis, particularly with PUH, poses a diagnostic challenge and may mimic abscesses, melanoma, or malignancies. Preoperative MRI can provide detailed assessments but is often unavailable in resource-limited settings. Conclusions Umbilical endometriosis should be considered in premenopausal women with umbilical pain, swelling, or discharge. Early diagnosis through clinical suspicion and comprehensive surgical management, including omphalectomy and hernia repair, followed by gynecological evaluation, ensures optimal outcomes.