July 2016 · Volume 5 · Issue 7 Page 2453 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Malik R et al. Int J Reprod Contracept Obstet Gynecol. 2016 Jul;5(7):2453-2456 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Case Report Menstruating umbilicus! A rare case report of primary umbilical endometriosis with review of literature Renuka Malik*, Preeti Sharma INTRODUCTION Extra pelvic endometriosis accounts up to 15% of all cases of endometriosis. Umbilical endometriosis has been reported to be around 0.4-4% of all patients with endometriosis and accounts for up to 30-40% of all cases of cutaneous endometriosis. 1 Other more common manifestation then primary umbilical endometriosis is scar endometriosis occurring in laparotomy scar. Primary umbilical endometriosis is a rare presentation, entity known among gynaecologists, but possibly unfamiliar to many other specialists. Due to the rarity of this entity, no guidelines for treatment exist. We report this case for its rarity with review of literature from 1990 onwards for optimal management of this condition. Written consent obtained from patient for publication of case and images. CASE REPORT Mrs. X, 45 year woman, para 2, presented to gynae OPD of DR. RML hospital, New Delhi on 6 February 2016, with complaints of pain and cyclical bleeding from her umbilicus for last 6 months. She also gave history of an umbilical nodule, which she first noticed 11 years back which was asymptomatic but since last 6 months had increased in size and had become painful. She gave history of increase in size and bleeding from nodule since last 5 months during her periods. There was no previous history of any surgery .There was no other history of pain abdomen, any menstrual irregularity, or bowel or urinary complaints. On examination a small 0.8 x 0.8 cm tender nodule was seen in umbilicus [Figure 1(A)]. P/S and P/V examination revealed 2 degree cervical descent with normal size uterus, mobile with no tenderness or any mass present in any fornix. To confirm her complaint, Department of Obstetrics and Gynaecology, PGIMER, RML Hospital, New Delhi, India Received: 06 May 2016 Revised: 03 June 2016 Accepted: 04 June 2016 *Correspondence: Dr. Renuka Malik, E-mail: renucam@yahoo.co.in Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Umbilical endometriosis (UE) represents 0.5% to 1% of all cases of extra genital endometriosis. Primary umbilical endometriosis is the presence of ectopic endometrial tissue located in the umbilicus in absence of previous surgery for either gynecological disorders or cesarean section which is defined as secondary umbilical endometriosis. Secondary UE, which is more common than primary UE and is probably due to the iatrogenic dissemination and implant of endometrial cells during either laparoscopic or open surgical procedures. Mrs. X, presented in OPD with an umbilical nodule since 6 months which grew in size and became painful and bled during periods. Imaging studies were done including MRI. A provisional diagnosis of umbilical endometriosis was made as patient had no history of any prior surgery. Patient had no suggestive history of pelvic endometriosis. Diagnostic laparoscopy was done to rule out concomitant pelvic endometriosis followed by wide local excision and umbilical reconstruction was done. By plastic surgeons. Knowledge of this rare condition and correct management is important to avoid recurrence. Medical treatment is only palliative not definitive in this condition. Keywords: Umbilical nodule, Extra pelvic endometriosis, Primary umblical endometriosis DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20162149