A parous woman, aged 35, presented with a complaint of regular bleeding from her umbilicus. According to her, this bleeding occurred in harmony with her normal menstruation, starting two days before menses and lasting its entire duration. This was her fourth month experiencing the same sequence. Not to mention, it caused swelling and pain in the umbilicus too.
The woman further told about her two vaginal deliveries without any significant complications. She did not report having any abdominal surgeries or hormonal contraception.
Clinical Examination for Such Unusual Menstruation
Clinical examination surfaced a 2cm by 2cm nodule wrapped up in a reddish-brown discharge. Suspecting an infection, the doctors covered it with a swab and started the woman’s treatment with a course of oral antibiotics. To their disappointment, it did no good as the woman returned after two months without any visible improvement in her symptoms.
Next, they subjected the patient to an abdominal ultrasound. It revealed a 15mm thin-walled cyst just below the skin in the umbilical region. Good thing, now they knew it wasn’t just some random bacterial infection. So, they scratched their heads over the condition’s temporal association with menstruation and concluded they were dealing with an umbilical endometriosis.
The Next Step?
With both medical and surgical treatments on the table, the patient opted for a medical management first. Thus she received Zoladex injections (AstraZeneca UK, Goserelin acetate, 3.6 mg subcutaneously, monthly) for three months. When it failed to roll in a decrease in umbilical swelling, the patient asked for a surgical excision. And rightly so, she got her nodule resected along with umbilical reconstruction.
Post-operative histology of the nodule confirmed the presence of endometrial glands with mucinous type hyperplasia. Anyhow, the patient was re-assessed six weeks after her surgery and to everybody’s delight, she came out to be completely asymptomatic. Just that the doctors told her it might recur. A joy-killer right?