Surgical management of umbilical endometrioma within an umbilical hernia

A nulliparous woman in her 40s is referred to gynaecological oncology secondary to umbilical pain and bleeding with menses. Examination revealed a blood-filled cystic mass within an umbilical hernia consistent with umbilical endometrioma. The patient exhausted medical management options, then pursued surgical management via umbilectomy, excision of umbilical endometriosis, lysis of adhesions and umbilical hernia repair. Surgical pathology revealed cystic endometriosis within a hernia sac. Postoperative course was complicated by a surgical site infection, which resolved with antibiotic treatment and ultrasound-guided percutaneous drainage. Few theories attempt to explain the pathogenesis of umbilical endometriosis. Medical management has not been well studied but may prove to be an effective first-line adjuvant strategy. Surgical management is reported to have a low-recurrence rate. Many techniques have been described for umbilical reconstruction, but a superior surgical technique has yet to be identified. The case presented discusses the management of a secondary endometrioma in an umbilical hernia.