Location
Suwanee, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
Background: Extrapelvic endometriosis is defined by the presence of endometrial-like tissue located outside the pelvic cavity and beyond the gynecologic organs. Its true prevalence remains difficult to establish due to limited epidemiologic data, under recognition and frequent diagnostic delay. Umbilical endometriosis represents approximately 30–40% of abdominal wall endometriosis cases and accounts for an estimated 0.5–1.0% of all reported endometriosis diagnoses. Clinical suspicion is typically based on symptomatology, as patients often present with dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility.
Objective: We present a case of umbilical endometriosis, also known as Villar’s nodule, identified during diagnostic laparoscopy performed for suspected pelvic endometriosis. A 32-year-old nulligravida woman presented as a new patient with a long-standing history of progressively worsening cyclic pelvic pain and dyspareunia beginning several years after menarche. Although she experienced partial symptom relief with nonsteroidal anti-inflammatory medications and combined oral contraceptives, her pain persisted and continued to worsen over time, ultimately prompting surgical evaluation.
Methods: Upon initial umbilical trocar insertion for diagnostic laparoscopy, an unexpected umbilical mass was encountered, prompting conversion to an open (Hasson) technique to allow improved visualization and safe entry. Intraoperatively, a 2 cm blue-brown umbilical nodule was identified on the inferior aspect of the umbilicus, extending through the fascia into the peritoneal cavity and adherent to the adjacent small bowel. The bowel was carefully dissected free from the lesion without injury.
Additional findings included multiple endometriotic implants measuring less than 0.25 cm within the posterior cul-de-sac and along the left pelvic sidewall, which were fulgurated. Filmy adhesions were noted between the posterior uterus and the posterior cul-de-sac and were sharply lysed.
The umbilical mass was excised in its entirety. Intraoperative frozen section analysis confirmed umbilical endometriosis, effectively excluding metastatic disease consistent with a Sister Mary Joseph nodule.
Results: At the 2-week postoperative follow-up visit, the incision site was well healed without evidence of erythema, drainage, fluctuance, or crepitus on examination. Final pathology results were reviewed with the patient. Continued use of combined oral contraceptives was recommended for hormonal suppression until pregnancy is desired, with the goal of reducing the risk of recurrence.
Conclusion: This case highlights that umbilical endometriosis may present as an unexpected intraoperative finding during evaluation for pelvic endometriosis. The unexpected identification of an umbilical mass during laparoscopy emphasizes that extrapelvic endometriosis may be clinically occult and discovered incidentally, reinforcing the need for careful intraoperative assessment and pathologic confirmation.
Embargo Period
6-1-2026
Included in
Recognizing extrapelvic disease: a case of umbilical endometriosis diagnosed at laparoscopy
Suwanee, GA
Background: Extrapelvic endometriosis is defined by the presence of endometrial-like tissue located outside the pelvic cavity and beyond the gynecologic organs. Its true prevalence remains difficult to establish due to limited epidemiologic data, under recognition and frequent diagnostic delay. Umbilical endometriosis represents approximately 30–40% of abdominal wall endometriosis cases and accounts for an estimated 0.5–1.0% of all reported endometriosis diagnoses. Clinical suspicion is typically based on symptomatology, as patients often present with dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility.
Objective: We present a case of umbilical endometriosis, also known as Villar’s nodule, identified during diagnostic laparoscopy performed for suspected pelvic endometriosis. A 32-year-old nulligravida woman presented as a new patient with a long-standing history of progressively worsening cyclic pelvic pain and dyspareunia beginning several years after menarche. Although she experienced partial symptom relief with nonsteroidal anti-inflammatory medications and combined oral contraceptives, her pain persisted and continued to worsen over time, ultimately prompting surgical evaluation.
Methods: Upon initial umbilical trocar insertion for diagnostic laparoscopy, an unexpected umbilical mass was encountered, prompting conversion to an open (Hasson) technique to allow improved visualization and safe entry. Intraoperatively, a 2 cm blue-brown umbilical nodule was identified on the inferior aspect of the umbilicus, extending through the fascia into the peritoneal cavity and adherent to the adjacent small bowel. The bowel was carefully dissected free from the lesion without injury.
Additional findings included multiple endometriotic implants measuring less than 0.25 cm within the posterior cul-de-sac and along the left pelvic sidewall, which were fulgurated. Filmy adhesions were noted between the posterior uterus and the posterior cul-de-sac and were sharply lysed.
The umbilical mass was excised in its entirety. Intraoperative frozen section analysis confirmed umbilical endometriosis, effectively excluding metastatic disease consistent with a Sister Mary Joseph nodule.
Results: At the 2-week postoperative follow-up visit, the incision site was well healed without evidence of erythema, drainage, fluctuance, or crepitus on examination. Final pathology results were reviewed with the patient. Continued use of combined oral contraceptives was recommended for hormonal suppression until pregnancy is desired, with the goal of reducing the risk of recurrence.
Conclusion: This case highlights that umbilical endometriosis may present as an unexpected intraoperative finding during evaluation for pelvic endometriosis. The unexpected identification of an umbilical mass during laparoscopy emphasizes that extrapelvic endometriosis may be clinically occult and discovered incidentally, reinforcing the need for careful intraoperative assessment and pathologic confirmation.