Umbilical endometriosis along with peritoneal endometriosis: a case report

T. Ramani Devi, C. Archana Devi, C. Aparna Devi
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2019 · vol. 8(5) , pp. 2106 · doi:10.18203/2320-1770.ijrcog20191977 · W2943096064
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This case report describes a 30-year-old woman with periodic umbilical bleeding and dysmenorrhea who was diagnosed with umbilical endometriosis, associated with early peritoneal endometriosis, and treated with surgical excision and laparoscopy.

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This paper reports a 30-year-old woman with periodic bleeding from the umbilicus and dysmenorrhea, in whom imaging and exam supported umbilical endometriosis with suspected pelvic involvement; CT showed a hypo-echoic umbilical lesion and an adenomyotic uterus with normal ovaries. The patient underwent laparoscopy, which demonstrated early peritoneal endometriosis and pelvic adhesions, followed by adhesiolysis and cauterization of endometriosis, with umbilical excision and layered closure. The authors note umbilical endometriosis could be primary or secondary (e.g., via lymphovascular spread from pelvic disease), and they explicitly state that follow-up is needed, but no outcomes beyond the case management are provided. This paper is centrally about endometriosis — it describes umbilical endometriosis with associated early peritoneal endometriosis and imaging evidence of adenomyosis.

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Abstract

Incidence of endometriosis is around 10 to 15% in women of reproductive age group. Umbilical endometriosis is a very rare entity. Extra genital endometriosis accounts to 3% of endometriosis. Incidence of umbilical endometriosis is 0.5%-4% of extra genital endometriosis. 30 years old multi gravida was referred to our hospital with c/o periodic bleeding from the umbilicus for the past 3 months. She was also having dysmenorrhoea for about 3 months. On examination, patient had a small bluish nodule in the umbilicus around 1.5x1.2 cm in size. Clinically there was suspicion of pelvic endometriosis as the uterus was retroverted and fixed. CT abdomen showed a small hypo-echoeic area in the umbilicus and uterus was adenomyotic with normal ovaries. Patient was given the option of laparoscopy and excision of umbilicus, as there was suspicion of peritoneal endometriosis and the patient also insisted upon laparoscopic sterilization. Laparoscopy showed early peritoneal endometriosis with pelvic adhesions and the same adhesiolysis was done along with cauterization of endometriosis. Sterilization was also done as per the patient’s request. Umbilical excision and layer closure was done. Umbilical endometriosis is a rare entity. This patient had associated early pelvic endometriosis. Umbilical endometriosis could be secondary to the lympho vascular spread from the pelvic endometriosis or primary umbilical endometriosis. History, clinical and imaging were pointing towards umbilical endometriosis. Surgical excision of umbilical endometriosis and cauterisation of early pelvic endometriosis were done. Patient needs follow up. Umbilical endometriosis may be primary or secondary which needs total excision and follow up.
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Umbilical endometriosis along with peritoneal endometriosis: a case report DOI: https://doi.org/10.18203/2320-1770.ijrcog20191977Keywords: Endometriosis, Laparoscopy, Peritoneum umbilicalAbstract Incidence of endometriosis is around 10 to 15% in women of reproductive age group. Umbilical endometriosis is a very rare entity. Extra genital endometriosis accounts to 3% of endometriosis. Incidence of umbilical endometriosis is 0.5%-4% of extra genital endometriosis. 30 years old multi gravida was referred to our hospital with c/o periodic bleeding from the umbilicus for the past 3 months. She was also having dysmenorrhoea for about 3 months. On examination, patient had a small bluish nodule in the umbilicus around 1.5x1.2 cm in size. Clinically there was suspicion of pelvic endometriosis as the uterus was retroverted and fixed. CT abdomen showed a small hypo-echoeic area in the umbilicus and uterus was adenomyotic with normal ovaries. Patient was given the option of laparoscopy and excision of umbilicus, as there was suspicion of peritoneal endometriosis and the patient also insisted upon laparoscopic sterilization. Laparoscopy showed early peritoneal endometriosis with pelvic adhesions and the same adhesiolysis was done along with cauterization of endometriosis. Sterilization was also done as per the patient’s request. Umbilical excision and layer closure was done. Umbilical endometriosis is a rare entity. This patient had associated early pelvic endometriosis. Umbilical endometriosis could be secondary to the lympho vascular spread from the pelvic endometriosis or primary umbilical endometriosis. History, clinical and imaging were pointing towards umbilical endometriosis. Surgical excision of umbilical endometriosis and cauterisation of early pelvic endometriosis were done. Patient needs follow up. Umbilical endometriosis may be primary or secondary which needs total excision and follow up. 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