The imposter at the navel: Primary umbilical endometrioma (Villar’s Nodule): A rare case report

Suganthi*

Senior Staff Nurse, Kauvery Hospital, Salem, Tamil Nadu

*Correspondence

Abstract

Umbilical endometrioma, also known as Villar’s nodule, is a rare form of extra pelvic endometriosis involving the umbilicus. It commonly presents as an umbilical swelling associated with cyclical pain, tenderness, discoloration, or bleeding during menstruation. Early recognition is important because an umbilical lesion can clinically resemble an umbilical hernia, granuloma, melanoma, or other umbilical tumors. We present a case of a woman with an umbilical nodule associated with cyclical symptoms. Clinical examination and imaging were performed, and the diagnosis was confirmed by histopathological examination. Complete surgical excision resulted in good clinical recovery.

Key words: Umbilical endometrioma; Villar’s Nodule; Endometriosis

Introduction

Endometriosis is a condition in which endometrial-like tissue occurs outside the uterine cavity. Although pelvic endometriosis is common, cutaneous endometriosis is uncommon, and umbilical involvement is particularly rare. Umbilical endometriosis accounts for a small proportion of extragenital endometriosis and is known as Villar’s nodule. Patients may present with an umbilical mass, cyclical pain, swelling, discoloration, or bleeding corresponding to menstruation. Diagnosis requires a high index of suspicion and is confirmed by histopathology.

Case Presentation

  • A 33yrs year-old female presented with an umbilical swelling for 2 years on and off. She reported pain/bleeding from umbilical region, which increased during menstruation. There was history of pelvic surgery.
  • Her menstrual cycles were irregular. There was no significant history of other relevant symptoms.
  • On examination, a 10*10 mm, dark nodule was noted at the umbilicus. The lesion was bleeding on and off.

Relevant clinical findings

  • Umbilical nodule/swelling
  • Cyclical pain associated with menstruation
  • Cyclical swelling or discoloration
  • Possible umbilical bleeding/discharge
  • Previous abdominal surgery (LSCS)
  • Vital signs: stable
  • Abdominal examination: Umbilical endometrioma+

Investigations – All within normal limits

CBC

Heamoglobin12.9
PCV39.4
RBC Count4.60
MCV85.7
W-CV12.6
WBC count7470
Platelet2.36

ECHO Findings

  • Normal chambers
  • No RWMA
  • Normal LV & RV systolic function
  • Trivial mitral regurgitation
  • Trivial tricuspid regurgitation
  • Normal PA pressure
  • No clot / vegetation / pericardial effusion

USG findings: 2*2 cm umbilical endometrioma

Diagnosis

  • Umbilical endometrioma (Villar’s nodule).
  • Sister Mary Joseph nodule

Management

  • The patient was managed with a multidisciplinary approach involving surgical and nursing care.
  • Surgical management:
  • Preoperative assessment
  • Complete local excision of the umbilical lesion
  • Specimen sent for histopathological examination
  • Umbilical reconstruction/closure as required

Medical management:

  • Analgesics for pain
  • Hormonal therapy may be considered for symptom control in selected patients
  • Treatment of associated pelvic endometriosis if present

Nursing management

  • Monitor vital signs.
  • Assess pain.
  • Maintain wound hygiene.
  • Observe for bleeding or infection.
  • Administer prescribed medications.
  • Provide postoperative wound care.
  • Educate regarding menstrual-related recurrence of symptoms.
  • Follow-up as advised.

Outcome

Following surgical excision, the patient showed good clinical improvement. The postoperative wound remained clean and healthy, with no evidence of infection or significant bleeding. Histopathological examination confirmed the diagnosis of umbilical endometrioma.

At follow-up, the patient reported improvement in umbilical symptoms

Discharge

The patient was discharged in a stable condition with advice regarding:

  • Wound care
  • Prescribed medications
  • Avoiding trauma to the surgical site
  • Follow-up with the surgical/gynecology team
  • Reporting recurrent swelling, pain, bleeding, discharge, or fever
  • Evaluation for associated pelvic endometriosis when clinically indicated

Conclusion

Umbilical endometrioma is a rare but important cause of an umbilical mass in women of reproductive age. A history of cyclical pain, swelling, discoloration, bleeding during menstruation should raise suspicion of Villar’s nodule. Complete surgical excision and histopathological confirmation are important for definitive management.

Reference

  • Konar HL. D.C. Dutta’s Textbook of Gynecology. 9th ed. Jaypee Brothers Medical Publishers.
  • Seshadri L, Arjun G. Essentials of Gynecology. 3rd ed. Wolters Kluwer; 2022.
  • Berek JS, editor. Berek & Novak’s Gynecology. 17th ed. Wolters Kluwer; 2025.

 

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