Concurrent Umbilical Endometriosis and Umbilical Hernia: A Rare Case

Endometriosis of the umbilicus is uncommon. Presenting symptoms are nonspecific and may mimic other diseases of the umbilicus, such as Sister Mary nodule, granuloma, melanoma, and umbilical hernia. Umbilical endometriosis and umbilical hernia can rarely occur together, and their clinical features can easily be confused. We present the case of a 34-year-old woman with a history of two cesarean deliveries attended at our center who complained of a reducible umbilical swelling of gradual onset, more marked during coughing and straining. Thereafter, she noticed another small dark bluish swelling developing on the umbilicus, which increased progressively over time. Near and during menstruation, the swelling became larger and more painful, and was later accompanied by cyclic umbilical bleeding. Physical examination revealed a darkish, firm umbilical swelling, which was non-tender and measured about 3 cm × 2 cm, as well as an abdominal wall defect measuring about 3 cm in the umbilical area. She underwent excision of the umbilical mass followed by surgical repair. The excised specimen was sent for histopathology, which confirmed an endometriosis of the umbilicus. Umbilical swelling has several differential diagnoses, which can be either primary or metastatic disease of the umbilicus. Concurrent umbilical endometriosis and umbilical hernia are rare, and their clinical features can easily be confused, causing difficulties in making an accurate diagnosis. Cyclic umbilical swelling, pain, and umbilical bleeding should raise the suspicion of umbilical endometriosis. This case report emphasizes the importance of thorough history taking, physical examination, and histopathological examination for all women presenting with ambiguous umbilical swelling.