Alleviating Bothersome Symptoms of Umbilical Endometriosis by En Bloc Resection in a Young, Fertile Patient

BACKGROUND: Abdominal wall endometriosis (AWE) is the most common extra-pelvic endometriosis encountered. Between 30% and 40% of AWE cases are umbilical endometriosis (UE), also known as Villar’s nodule. This is a rare form of endometriosis, accounting for only 0.5% to 4% of extragenital seedings.  METHODS: We present a case of UE in a young, fertile female treated with en-bloc resection of the nodule in accordance with the Surgical Case Report (SCARE) guidelines.  RESULT: A 35-year-old female presented with a persistent, painful, discolored mass in the umbilical region. An initial physical examination revealed a 2x2x2 cm discolored mass protruding from the umbilicus, accompanied by cyclical bleeding coinciding with her menstrual cycle. The mass was excised along the umbilicus, extending to the _linea alba_ and peritoneum. To ensure the complete removal of all endometrial tissue from the nodule margins, a specimen was sent for a frozen section, confirming the presence of endometrial tissue and clear margins. A vertical two-lateral flap _neoumbilicoplasty_ was performed. The patient exhibited no recurrent lesions, and the _neoumbilicoplasty _resulted in good cosmetic outcomes. CONCLUSION: En-bloc resection and excision of the underlying peritoneum is the best choice for treating UE. A vertical umbilical reconstruction after excision offers excellent cosmetic results.