Extra-pelvic endometriosis is endometriosis that occurs in organs such as the diaphragm, appendix, thorax (chest cavity), bowels, pancreas, and sciatic nerve. Umbilical endometriosis is a rare form of extra-pelvic endometriosis. It results from the presence of endometrial tissue in the umbilicus or belly button. These lesions are also known as Villar’s nodules after the scientist who first described them in 1886.
About the umbilicus
The umbilicus, commonly known as the navel or belly button, marks the spot where the umbilical cord attaches to the developing fetus. The umbilical cord ensures blood and nutrient flow between the placenta of the mother and the fetus. Doctors cut off the umbilical cord after delivery. They leave behind a stump which is the umbilicus or belly button.
What is umbilical endometriosis?
Umbilical endometriosis is a rare condition that occurs in just 0.5 to 1% of endometriosis cases. It presents itself as a painful, discolored swelling in the umbilicus that is difficult to distinguish from other kinds of nodules such as umbilical hernias.
Causes for umbilical endometriosis
Like other forms of endometriosis, the exact cause of umbilical endometriosis is not clear.
One theory is that endometrial cells travel to the umbilicus via the lymphatic system, abdominal cavity, or remnant umbilical vessels. This is primary umbilical endometriosis.
Metaplasia (the replacement of one differentiated cell type with another differentiated cell type) of the urachus (a tube that extends from the bladder to the umbilical cord) remnants could also lead to umbilical endometriosis.
Secondary umbilical endometriosis may occur iatrogenically due to the spread of endometrial cells following a Caesarean section or laparoscopic surgery.
The umbilical nodule may cause pain that coincides with monthly cycles along with heavy and painful menstruation.
Continuous pain near the umbilical region that is not related to the menstrual cycle may also occur. This can happen when umbilical endometriosis occurs together with umbilical hernias.
Another symptom could be intense pain and bleeding near the umbilical region during menstruation.
Finally, a case study reported umbilical lumps that become large and tender before the onset of menstruation.
Doctors should evaluate all premenopausal women with umbilical swelling and symptoms that coincide with monthly cycles for umbilical endometriosis.
Nearly 25% of umbilical endometriosis cases often see concurrent pelvic endometriosis.
Physically, the nodule could have a brown, blue, or dark discoloration.
Ruling out other disorders is essential in order to confirm umbilical endometriosis. Benign nodules in the umbilicus may be due to conditions such as a hernia, endosalpingiosis, hemangioma, lipoma, subcutaneous cysts, keloids, and abscess while malignant nodules may be due to melanoma, sarcoma, adenocarcinoma, lymphoma, or a lymph node that is draining a malignant tumor from elsewhere in the body (Sister Mary Joseph Nodule).
Imaging techniques such as transvaginal ultrasound, sonohysterography, magnetic resonance imaging (MRI), hysteroscopy, and laparoscopy may help diagnose the condition and determine the presence of underlying hernia and the size of the nodules. However, the sensitivity of these techniques is not clear.
Laparoscopic excision surgery followed by histopathological examination is the gold standard to confirm umbilical endometriosis like all types of endometriosis. Umbilical endometriosis can be removed with an abdominal excision. However laparoscopic surgery is also warranted to examine the pelvis for any remaining endometriosis and excising it.
Symptom management using hormonal therapy or GnRH agonists can only provide temporary relief and there is a high likelihood that symptoms may recur after cessation of such therapies.
Excision surgery is the only way to fully excise all umbilical lesions and prevent symptom recurrence.
At Seckin Endometriosis Center, we use our patented Aqua Blue Contrast technique combined with cold excision to identify and remove all kinds of endometrial lesions. Laparoscopic excision surgery also allows the surgeon to remove concomitant endometriosis lesions in other areas of the pelvis.
Excision of the umbilical lesion is followed by the reconstruction of the muscles around the umbilicus (fascial and subfascial reconstruction). If there’s an underlying umbilical hernia, we excise the hernia sac along with the umbilical endometriosis nodule en-bloc to minimize the chance of disease recurrence.
Ready for a Consultation?Our endometriosis specialists are dedicated to providing patients with expert care. Whether you have been diagnosed or are looking to find a doctor, they are ready to help.
Our office is located on 872 Fifth Avenue New York, NY 10065.
You may call us at (212) 988-1444 or have your case reviewed by clicking here.