title: Concurrent appendiceal and umbilical endometriosis: a case report and review of the literature.
abstract: BACKGROUND
  Endometriosis affects 3 to 10 percent of women of reproductive age. Most of the time it involves the pelvis; however, sites of endometriosis have been reported almost anywhere in the body. Appendiceal and primary umbilical endometriosis are considered rare loci, making accurate diagnosis elusive. Here we present the case of a 46-year-old woman with concurrent appendiceal and umbilical endometriosis.
  
  
  METHODS
  A 46-year-old Greek woman presented with a large mass in the lower abdomen adhering to the surrounding organs. She reported recurrent lower abdominal and pelvic pain and the presence of a dark-blue hard nodule at the umbilicus. She had no previous medical, surgical or gynecological history. Her physical examination and laboratory test results were without any significant findings. The laparotomy revealed a fibromatose uterus adhering to the rectum and a urinary cyst and a palpable mass in the vermiform appendix. A hysterectomy and an appendectomy were performed. The umbilical mass was also excised. Pathology revealed endometriosis of the umbilicus and the appendix. The postoperative period was uneventful and she was discharged.
  
  
  CONCLUSIONS
  Endometriosis, although rare, should always be considered in women of reproductive age, presenting with cyclic pain. The diagnosis is, most of the time, difficult and requires a high degree of clinical suspicion. The clinical doctor should be aware that endometriosis can sometimes be multifocal, thus a thorough investigation is required in all cases.
authors: Daniel
authors: D
authors: Paramythiotis
authors: George
authors: G
authors: Stavrou
authors: First Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, St Kyriakidi 1, 54636 Thessaloniki, Greece. st.panidis@gmail.com.
authors: Stavros
authors: S
authors: Panidis
authors: Dimitris
authors: D
authors: Panagiotou
authors: Kyriakos
authors: K
authors: Chatzopoulos
authors: Vasileios N
authors: VN
authors: Papadopoulos
authors: Antonios
authors: A
authors: Michalopoulos
mesh_terms: D001062:Appendectomy; D001065:Appendix; D002429:Cecal Diseases / Q000175:diagnosis*; D004715:Endometriosis / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007889:Leiomyoma / Q000601:surgery; D008875:Middle Aged; D012871:Skin Diseases / Q000175:diagnosis*; D014472:Umbilicus / Q000473:pathology*; D014594:Uterine Neoplasms / Q000601:surgery