Primary Umbilical Endometriosis in an Adolescent Girl: Unsuspected Pathology

Leel Nellihela, Mudher Al-Adnani, Mudher Al‐Adnani, Dorothy Kufeji
European journal of pediatric surgery reports · 2020 · vol. 08(01) , pp. e10–e13 · doi:10.1055/s-0039-1700987 · PMID:32042547 · W3005236919
article OA: gold CC0 ⤵ 15 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This case report describes the surgical excision and histological diagnosis of primary umbilical endometriosis in a 16-year-old girl, highlighting its consideration in painful umbilical lesions.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This paper reports a case of primary umbilical endometriosis in a 16-year-old girl who presented with a painful, dark, irreducible umbilical lump over 2–3 months, alongside precocious puberty, cyclical vomiting, and menorrhagia; clinicians initially suspected an incarcerated umbilical hernia. After ultrasound suggested a hernia-like mass with no bowel involvement, urgent surgical exploration found a dark, firm nodule excised with surrounding skin, fat, and fascia, and histology (including CD10 immunostaining) confirmed endometriosis, with follow-up showing symptom resolution and wound healing at 6 months. The authors emphasize that imaging cannot definitively diagnose umbilical endometriosis and that complete excision with histology is recommended to exclude malignancy and reduce recurrence, noting that MRI was not performed because endometriosis was not suspected preoperatively. This paper is centrally about endometriosis — specifically primary umbilical endometriosis presenting as an unsuspected painful umbilical lesion in an adolescent girl, with implications for differential diagnosis and management.

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Abstract

Endometriosis affects 7 to 10% of women of reproductive age. Primary umbilical endometriosis (PUE) is even rarer with unclear pathogenesis. We report a case of PUE possibly the youngest patient reported in the literature. A 16-year-old girl of African origin presented with painful umbilical lump for 2 to 3 months duration with background history of precocious puberty, cyclical vomiting, and menorrhagia. Clinical examination showed dark-colored, tender, irreducible umbilical lump. A provisional diagnosis of incarcerated umbilical hernia was made. Abdominal X-ray showed no features of intestinal obstruction. Ultrasound scan of the abdomen showed lump containing heterogeneous echogenic material measuring 2.0 × 1.5cm within the umbilicus with no visible bowel loops or peristalsis. This was reported as consistent with an umbilical hernia with narrow neck possibly containing mesentery or intra-abdominal fat. The patient underwent urgent exploration of umbilicus under general anesthetic. At operation, a dark-colored, firm mass was excised and sent for histology. The underlying fascia and peritoneum were repaired. Histological examination confirmed the excised tissue was endometriosis. Follow-up continues in the endometriosis clinic. Umbilical endometriosis should be considered in differential diagnoses of painful umbilical lesion in adolescent girls and women of reproductive age. Complete excision and histology are highly recommended for obtaining a definitive diagnosis, to exclude malignancy and to prevent recurrence.

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endometriosis

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