Umbilical reconstruction for endometriosis: A case report

Introduction

Umbilical endometriosis is a rare form of cutaneous endometriosis characterized by the presence of ectopic endometrial tissue in the umbilical skin. This condition may arise spontaneously or secondary to surgical procedures.

Case presentation

A 30-year-old nulliparous woman presented with a three-month history of a painful, hyperpigmented umbilical nodule that worsened during menstruation, following laparoscopic resection of a urachal cyst one year earlier. Physical examination revealed a 2 cm firm nodule, and imaging confirmed a subcutaneous umbilical mass without evidence of pelvic endometriosis. Given the cyclical nature of symptoms, umbilical endometriosis was suspected, and surgical excision with a 1 cm margin was performed, followed by immediate umbilical reconstruction using a modified purse-string technique. Histopathological analysis confirmed endometriosis with no signs of malignancy, and the patient was started on GnRH agonist therapy postoperatively. At 3- and 12-month follow-ups, the patient had no recurrence, and the reconstructed umbilicus maintained a satisfactory aesthetic result.

Clinical discussion

Umbilical endometriosis is a rare form of cutaneous endometriosis, typically presenting as a painful, hyperpigmented umbilical nodule with cyclical symptoms tied to menstruation. Diagnosis relies on clinical suspicion, imaging, and is confirmed by histopathology. Surgical excision remains the definitive treatment, often followed by immediate umbilical reconstruction using techniques such as the purse-string method for optimal aesthetic outcomes. Adjunctive hormonal therapy may help manage residual symptoms and reduce recurrence risk.

Conclusion

This case highlights the importance of including umbilical endometriosis in the differential diagnosis of umbilical masses and demonstrates effective management through surgical excision and reconstruction.