Umbilical endometriosis: A rare diagnosis in plastic and reconstructive surgery

Abstract

E ndometriosis is a disease characterized by the presence of uterine tissue outside the endometrium and myometrium (1). It can clinically manifest with dysmenorrhea, dyspareunia, cyclical or noncyclical pelvic pain and subfertility. Occurring in 8% to 15% of menstruating women (2), it most commonly presents in the ovaries, uterine ligaments, rectovaginal septum and peritoneum (3). Endometriosis can less commonly present in other sites such as the intestines, appendix, lungs and kidneys (4). The cutaneous variant of endometriosis is much rarer and has been reported to account for approximately 1% of all cases (5). Cutaneous endometriosis is most prevalent at sites of surgical scars such as those from caesarean sections, episiotomies, hysterectomies, laparoscopies and other abdominal surgeries (2-4,6,7). According to Friedman and Rico (6), umbilical endometriosis with no previous abdominal or pelvic surgery is even less common. Patients with cutaneous endometriosis typically present to the gynecologist and the dermatologist. If they have a history of pelvic or abdominal surgery, then they can also present to the general surgeon. There have been only 81 published reports of 'umbilical endometriosis' in the world between 1953 and 2008. Although patients with umbilical endometriosis infrequently present to the plastic surgeon, we present such a case and suggest that it be kept on the plastic surgeon's differential diagnosis for umbilical lesions.

Joint Treatment of De Novo Umbilical Endometriosis with Plastic Surgery and Minimally Invasive Gynecologic Surgery

“…There is a range of published surgical techniques for reconstruction of the umbilicus. 3–8 In this case, we document the novel use of the four-flap approach for the treatment of umbilical endometriosis 3,4,9 (Fig. 4).…”

“…Alternatively, the purse string and perforator flap methods have been documented techniques for umbilicoplasty in cases of umbilical endometriosis 4,10 However these techniques can lead to stenosis of the umbilicus with a shallow scar. The four-flap technique leaves no visible scars, has a low complication rate, and is associated with high patient satisfaction.…”

Primary Umbilical Endometriosis Coexisting with Multiple Uterine Myomas : A Rare Case Report

“…[32,33,34] Fine needle aspiration cytology can be supplementary, but results have been reported to be inconclusive in as high as 75% of cases. [35] A high level of tumour makers such as CEA and CA 125 may raise the suspicion of concomitant pelvic endometriosis.…”

Primary Umbilical Endometriosis: Unusual Clinical Presentation with Microscopic Diagnosis

“…Endometriosis is defined by the presence of endometrial glands and stroma outside the uterine cavity [1,2] . It affects 7-10% of women of reproductive age presenting with dysmenorrhea, menorrhagia, pelvic pain, and infertility [3,4] and commonly occurs in the pelvic organs [5,6] , mostly the ovaries, the Fallopian tubes, the utero-sacral ligaments, and the recto-vaginal septum [7,8] .…”