Umbilical endometriosis

Specialty: Gynecology and breast.

• Endometriotic Sister Mary Joseph nodule
• umbilical catamenial node
• endometriosis of the umbilical scar

Why it occurs

• Presence of functional ectopic endometrial tissue located in the umbilical scar (originated primarily by migration through the vestiges of the umbilical vessels or urachus, or secondarily after previous laparoscopic surgeries with extraction of pieces through the umbilical port), which suffers from inflammation and menstrual cyclical blood shedding.

Initial workup

High resolution ultrasound of the umbilical abdominal wall (shows a hypoechoic, irregular solid nodule, with microcystic areas inside, located in the umbilical subcutaneous tissue and ruling out herniated fascial communication). Magnetic resonance imaging of the abdomen and pelvis to evaluate the depth of the nodule and rule out the presence of peritoneal endometriosis or associated deep pelvic foci. Core needle biopsy (CNB) or direct excisional biopsy for histological confirmation.

Standard management

• There are no drugs that permanently eradicate the established umbilical node. Pain and bleeding can be temporarily mitigated by using Dienogest 2 mg orally daily uninterruptedly or combined contraceptives on a continuous regimen to induce amenorrhea. The definitive treatment of choice is complete surgical removal of the umbilical nodule with free margins and reconstruction of the umbilical scar (omphaloplasty), which should preferably be performed outside the period of menstruation to avoid local tissue dissemination (note: always rule out concomitant wall hernias before making blind incisions).