Primary umbilical endometriosis in a nulliparous woman: A rare case report

Endometriosis describes the presence of endometrial tissue outside the uterine cavity. These patients often experience cyclic pain, dysmenorrhea, dyspareunia and infertility. Extra-pelvic endometriosis, particularly at the umbilicus, is rare. The exact incidence of endometriosis is unknown; definitive diagnosis requires surgical exploration and histopathological confirmation. Conservative, medical and surgical approaches are used in treatment. A combined approach is most useful in cases where pain is a prominent symptom. There is limited discussion of umbilical endometriosis in the literature, most information is derived from case reports.

Herein we present the case of a 35-year-old nulliparous woman in Northern Tanzania with a 10-year history of infertility. On presentation this patient reported a three-year history of a cyclical aching pain associated with an umbilical mass. An abdominal MRI revealed an ill-defined, enhancing mass measuring 3 × 4 × 6 cm located along the right anterior abdominal wall. The mass was connected to a sinus tract extending inferiorly to the suprapubic region but showed no communication with the peritoneal cavity, suggestive of endometriosis. Furthermore, bilateral adnexal lesions demonstrated hyperintense signals with focal hypointense areas and variable restrictions, consistent with bilateral ovarian endometriomas. The patient underwent excision of the umbilical mass, and histopathological examination confirmed the diagnosis of primary umbilical endometriosis. Despite her stable condition following management, she did not conceive over the course of the following year.

This case describes a case of primary umbilical endometriosis and bilateral ovarian endometriomas in a 35-year-old nulliparous woman. Surgical excision and histopathological analysis confirmed endometriosis. However, following intervention the patient was still unable to conceive. Whilst this is perhaps not unsurprising given the patient's age it is important for us to consider all possible explanations for her infertility. Critically, this case emphasizes the need for early intervention and comprehensive management of endometriosis-related fertility challenges.

We aim to provide a detailed description of this case in order to support clinicians who may encounter similar cases in the future especially in resource poor settings. We are providing data to support the theory that primary umbilical endometriosis can occur spontaneously in patients without a surgical history. Enhancing clinician awareness of this condition and fostering interdisciplinary collaboration is fundamental in providing timely support in relation to fertility challenges and symptom relief.