Large umbilical endometrioma: A case study

A 39-year-old woman complained of severe umbilical pain and dysmenorrhea. The pain was initially limited to her menstrual periods but had later transgressed to a constant, sharp, and debilitating pain accompanied by cyclic bleeding. 

The lady had previously given birth once. 

Upon physical examination, a firm, tender mass measuring 4×6 cm was discovered at the umbilicus. Imaging studies confirmed the presence of a corresponding mass at the umbilicus and an ovarian endometrioma. A collaborative surgical procedure involving both gynecology and general surgery was planned.

The Stage 4 endometriosis was intervened laparoscopically. Thereafter, a circular incision was made around the umbilical mass, which was then raised from the underlying posterior fascia. Healthy subcutaneous fat was identified all around the area. The anterior sheath on the sides was carefully preserved and mobilized to bring it back to the midline using figure-of-eight 0 monofilament delayed absorbable sutures while subcutaneous closure was accomplished using size 2-0 braided absorbable sutures. 

During follow-up, the patient exhibited a well-healed incision with no pain or signs of hernia. Pathological examination confirmed the diagnosis of an abdominal wall endometrioma.

Source: Warshafsky C, Corran B, Glen P, Busca A, Singh SS. American Journal of Obstetrics and Gynecology. 2023 Mar 17;229(3):333-336