Umbilical Endometriosis after Laparoscopic Subtotal Hysterectomy: Three Case Reports

Satoshi Kawai, Yukito Minami, Mayuko Ito, Hironori Miyamura, Akira Yasue, Eiji Nishio, Haruki Nishizawa, Kazuhiko Tsukada, Takao Sekiya, Yutaka Hirota, Takuma Fujii, Yuka Kiriyama, Makoto Kuroda
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2013 · vol. 29(1) , pp. 189–194 · doi:10.5180/jsgoe.29.189 · W2320190149
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⚙ AI-generated summary by claude@2026-06, 2026-06-12 ⓘ

This paper describes three cases of umbilical endometriosis developing after laparoscopic subtotal hysterectomy, likely due to the implantation of endometrial tissue during specimen removal.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-12 · read from full text ⓘ

This paper reports three case studies of umbilical endometriosis developing after laparoscopic subtotal hysterectomy (LSH) performed for uterine myoma in patients without endometriotic lesions at the time of surgery. Across cases, uterine tissue was removed and extracted through the umbilical region using techniques including an umbilical trocar, morcellation, and extraction, with umbilical induration and, in one case, hemorrhagic changes appearing 12–70 months postoperatively; pathology in all three cases confirmed heterotopic endometriosis. One case experienced recurrence after resection and showed resolution on dienogest before tumor reappearance after stopping treatment, leading to additional surgical resection. The main limitation is that these are descriptive case reports without a control group, so causal pathways are inferred rather than proven. This paper is centrally about endometriosis — specifically, it documents rare umbilical (heterotopic) endometriosis occurring after laparoscopic subtotal hysterectomy.

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Abstract

We report three cases in which umbilical endometriosis developed after a laparoscopic subtotal hysterectomy (LSH) for uterine myoma without endometriotic lesions.Case 1: A 36-year-old, gravida 2, para 2 underwent an LSH for uterine myoma. Removal of the uterus was performed using the peeling technique with an umbilical trocar. Twelve months postoperatively, induration appeared at the umbilical region (approximately 20 mm) and the right trocar region (approximately 5 mm). Therefore, a lumpectomy was performed 18 months after the initial surgery. The pathologic diagnosis was heterotopic endometriosis. Because the umbilical tumor relapsed 27 months following surgery, Dienogest was administered; eight months later, the tumor had resolved. The umbilical tumor reappeared two months after terminating the orally administered treatment; therefore, resection of the umbilical tumor was performed 55 months after the initial surgery.Case 2: A 44-year-old gravida 3, para 2 underwent an LSH for uterine myoma. The tumor was morcellated using a morcellator, then extracted using an umbilical trocar. Approximately 19 months postoperatively, an approximately 18 mm area of induration appeared near the umbilical region; therefore, a resection was performed. The pathological diagnosis was heterotopic endometriosis.Case 3: A 45-year-old gravida 2, para 2 underwent an LSH and left salpingectomy for a uterine myoma and left paraovarian cyst. The hysterectomy involved morcellation and extraction through the umbilical region. An approximately 46 mm area of induration with hemorrhage appeared in the umbilical region 70 months postoperatively. Due to the suspicion of an umbilical tumor, a needle biopsy was performed at the site; the pathologic diagnosis was heterotopic endometriosis. She is currently receiving Dienogest treatment as an outpatient, and is being followed-up with the possibility of surgical extraction in mind.Conclusion: Although endometriosis is a common gynecological disease, umbilical endometriosis is rare. Therefore, the disease that developed in these three cases was likely due to growth of endometrial tissue in the umbilical region at the time of tissue removal.
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Keywords

umbilical endometriosis, laparoscopic surgery 2013 Volume 29 Issue 1 Pages 189-194 Details

Abstract

We report three cases in which umbilical endometriosis developed after a laparoscopic subtotal hysterectomy (LSH) for uterine myoma without endometriotic lesions. Case 1: A 36-year-old, gravida 2, para 2 underwent an LSH for uterine myoma. Removal of the uterus was performed using the peeling technique with an umbilical trocar. Twelve months postoperatively, induration appeared at the umbilical region (approximately 20 mm) and the right trocar region (approximately 5 mm). Therefore, a lumpectomy was performed 18 months after the initial surgery. The pathologic diagnosis was heterotopic endometriosis. Because the umbilical tumor relapsed 27 months following surgery, Dienogest was administered; eight months later, the tumor had resolved. The umbilical tumor reappeared two months after terminating the orally administered treatment; therefore, resection of the umbilical tumor was performed 55 months after the initial surgery. Case 2: A 44-year-old gravida 3, para 2 underwent an LSH for uterine myoma. The tumor was morcellated using a morcellator, then extracted using an umbilical trocar. Approximately 19 months postoperatively, an approximately 18 mm area of induration appeared near the umbilical region; therefore, a resection was performed. The pathological diagnosis was heterotopic endometriosis. Case 3: A 45-year-old gravida 2, para 2 underwent an LSH and left salpingectomy for a uterine myoma and left paraovarian cyst. The hysterectomy involved morcellation and extraction through the umbilical region. An approximately 46 mm area of induration with hemorrhage appeared in the umbilical region 70 months postoperatively. Due to the suspicion of an umbilical tumor, a needle biopsy was performed at the site; the pathologic diagnosis was heterotopic endometriosis. She is currently receiving Dienogest treatment as an outpatient, and is being followed-up with the possibility of surgical extraction in mind.

Conclusion

Although endometriosis is a common gynecological disease, umbilical endometriosis is rare. Therefore, the disease that developed in these three cases was likely due to growth of endometrial tissue in the umbilical region at the time of tissue removal. Case 1: A 36-year-old, gravida 2, para 2 underwent an LSH for uterine myoma. Removal of the uterus was performed using the peeling technique with an umbilical trocar. Twelve months postoperatively, induration appeared at the umbilical region (approximately 20 mm) and the right trocar region (approximately 5 mm). Therefore, a lumpectomy was performed 18 months after the initial surgery. The pathologic diagnosis was heterotopic endometriosis. Because the umbilical tumor relapsed 27 months following surgery, Dienogest was administered; eight months later, the tumor had resolved. The umbilical tumor reappeared two months after terminating the orally administered treatment; therefore, resection of the umbilical tumor was performed 55 months after the initial surgery. Case 2: A 44-year-old gravida 3, para 2 underwent an LSH for uterine myoma. The tumor was morcellated using a morcellator, then extracted using an umbilical trocar. Approximately 19 months postoperatively, an approximately 18 mm area of induration appeared near the umbilical region; therefore, a resection was performed. The pathological diagnosis was heterotopic endometriosis. Case 3: A 45-year-old gravida 2, para 2 underwent an LSH and left salpingectomy for a uterine myoma and left paraovarian cyst. The hysterectomy involved morcellation and extraction through the umbilical region. An approximately 46 mm area of induration with hemorrhage appeared in the umbilical region 70 months postoperatively. Due to the suspicion of an umbilical tumor, a needle biopsy was performed at the site; the pathologic diagnosis was heterotopic endometriosis. She is currently receiving Dienogest treatment as an outpatient, and is being followed-up with the possibility of surgical extraction in mind.

Conclusion

Although endometriosis is a common gynecological disease, umbilical endometriosis is rare. Therefore, the disease that developed in these three cases was likely due to growth of endometrial tissue in the umbilical region at the time of tissue removal. © 2013 Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy Favorites & Alerts Recently viewed articles

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