Endometriosis is a benign inflammatory disease characterized by the
presence of estrogen dependent extra-uterine endometrial glands effecting 10%
at the reproductive age of the women. It presents with a conglomerate of
symptoms like turbulence of hormonal imbalances, chronic pain and infertility. However, endometriosis of the umbilical region is infrequent and when present
in an umbilical hernia, it is exceptionally precocious.
Umbilical endometriosis is further classified as primary if it
occurs spontaneously or secondary if it results from iatrogenically-seeded
endometrial implants following various surgical procedures, with the latter
being more common. The pathogenesis of primary umbilical endometriosis remains
unclear. Possible theories for this disorder could be the migration of
endometrial cells to the umbilicus through the abdominal cavity, the lymphatic
system, or through the embryonic remnants in the umbilical fold such as the
urachus and the umbilical vessels, genetic predisposition, and immunological
defects.
In this paper, the authors presented a case of recurrent umbilical
swelling, simple enough to be easily dismissed but complex enough to contain
endometrial tissue and confuse with a sister josephs nodule. Especially that
the clinical presentation was not as typical as expected.
The patient was a
37-year-old female with a past medical/surgical history of a subtotal colectomy
for ulcerative colitis in 2001 followed by an ileo-rectal anastomosis. 17 years
later, she was referred to the surgical outpatient clinic from GP practice with
a painful umbilical/incisional hernia surrounding the previous scar and just
above the umbilicus, this pain, particularly worsening during her menstrual
cycle. Multiple blood tests and ultrasound scans of her abdomen failed to
diagnose a cause for her agony which mandated an elective excision of the
swelling. This successfully resolved her symptoms.
In conclusion, umbilical
endometriosis is a potential diagnosis in females with a painful umbilical
swelling, imaging has no diagnostic role and excision is the definitive
treatment. And surgical site associated umbilical
endometriosis is a relatively rare form of endometriosis, which leads to
delayed presentation to the surgeons after all investigations fail to diagnose
a disease. The suspicion of the diagnosis of umbilical endometriosis is based
on the clinical presentation, but the definitive diagnosis should always be
confirmed by histological examination following biopsy or resection.
Article by Shahd
Nour, et al, from Queen’s Hospital Burton NHS Foundation Trust,
Burton-on-Trent, UK.
Full access: http://t.cn/E4G86Dm
Image by cabriolet2008, from
Flickr-cc.
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