Clinical Features and Management of Umbilical Endometriosis: A 30 Years’ Monocentric Retrospective Study

Abstract

Introduction: Umbilical endometriosis (UE) is defined as the presence of endometrial-like tissue within the umbilicus and represents around 0.5–1% of all cases of endometriosis. UE is classified into primary or secondary UE. In this retrospective study, we aimed to assess symptoms, signs, recurrence rate of treated lesions, psychological wellbeing and health-related quality of life in women with UE. Material and methods: We retrospectively reviewed all cases of women diagnosed with UE in the period 1990–2021 in our center. Post-operative recurrence of UE was considered as the reappearance of the umbilical endometriotic lesion, or as the recurrence of local symptoms in the absence of a well-defined anatomical recurrence of the umbilical lesion. Moreover, participants were invited to fill in standardized questionnaires on their health conditions. Results: A total of 55 women with histologically proven UE were assessed in our center during the study period. At time of diagnosis, local catamenial pain and swelling were reported by 51% and 53.2% of women, respectively. A total of 46.8% of women reported catamenial umbilical bleeding. Concomitant non-umbilical endometriosis was identified in 66% of cases. As regards the treatment of UE, 83.6% of women underwent an en-bloc excision with histological confirmation of UE. During the follow-up period, 37 women (67.3%) agreed to undergo a re-evaluation. Recurrence of either umbilical symptoms, or umbilical nodule, was observed in 27% of patients, 11% of which did not receive post-operative hormonal therapy. Specifically, a recurrence of the umbilical endometriotic lesion was observed only in two women. Among the 37 women which we were able to contact for follow-up, 83.8% were satisfied with the treatment they had received. Conclusions: The high rate of patient satisfaction confirmed that surgical excision should be considered the gold standard treatment for umbilical endometriosis. Future studies should investigate the role of post-operative hormonal therapy, particularly in reducing the risk of symptom recurrence.

RETRACTED: Primary umbilical endometriosis: Surgical case report

“…Umbilical endometriosis recurrence following surgical resection has been reported to be varying from 5.4% to 27%. 2,7 Hirata et al suggests that recurrences following wide resection including the peritoneum, with or without umbilical reconstruction, considerably reduce recurrence, emphasizing therefore the importance of extensive resection that includes the fascia and peritoneum making surgical therapy the first choice of treatment for umbilical endometriosis. 7 Malignant transformation of the umbilical nodule has been described in literature with a reported risk of malignant transformation to be 3%.…”

“…Catamenial local pain and swelling are the most common complaints, whereas umbilical bleeding was reported less frequently. 2 Pathogenesis of atypical endometriosis location can be explained by retrograde menstruation into the peritoneal cavity during menstruation. 3 However, the exact pathogenesis of primary endometriosis is still unclear.…”

Coexistence of Primary Umbilical Endometriosis and Endometrial Hyperplasia: A Case Report and Review of the Literature

“… 3 , 12 Endometrial cells can spread through the blood or lymphatic system from the peritoneum to the umbilicus through obliterated umbilical arteries, metaplasia of the urachus remnant, or the release of endometrial cells that can contaminate the emergence of the umbilical cord during labor and delivery. 6 , 8 , 9 …”

A surgical case report on primary umbilical endometriosis (Villar’s nodule)

“…The most common symptoms include abdominopelvic pain, dysmenorrhea, heavy menstrual bleeding, and infertility, although 20%–25% of women with the condition are asymptomatic. 2 …”

“… 3 Umbilical endometriosis, a rare variant of the disease, was first reported in 1886. 2 Its incidence is estimated at 0.5%–1% of women with extragenital endometriosis, including secondary and spontaneous primary forms. 4 …”