title: Spontaneous endometriosis associated with an umbilical hernia: A case report and review of the literature.
abstract: BACKGROUND
  Umbilical endometriosis occurring in the presence of an underlying hernia is extremely rare and presents a diagnostic challenge for the general surgeon. We present an interesting case and perform a comprehensive review of the literature.
  
  
  METHODS
  Medline and PubMed were queried for all cases of spontaneous umbilical endometriosis associated with an umbilical hernia. Data was analyzed and is presented along with an interesting case.
  
  
  RESULTS
  Only 7 cases have been reported in the literature. Median age was 38 years. Time to presentation was long (up to 5 years) and the majority had cyclical symptoms related to menstruation. All patients, including our case, were treated surgically.
  
  
  CONCLUSIONS
  Spontaneous umbilical endometriosis with an underlying hernia is often missed preoperatively. Preoperative suspicion warrants axial imaging for better operative planning and patient counseling. Surgery consists of enbloc excision of the umbilicus, implant and the hernia sac to avoid residual disease and reduce recurrence. The hernia defect can be repaired primarily or using mesh and the umbilicus reconstructed using skin flaps if necessary.
  
  
  CONCLUSIONS
  Surgery is the mainstay of therapy for umbilical endometriosis associated with an underlying hernia. Clinical suspicion warrants preoperative imaging, and follow-up with a gynecologist is essential to address any pelvic disease.
authors.affiliation: The University of Texas Health Science Center at Tyler, Tyler, TX, USA. Electronic address: Hishaamismael@gmail.com.
authors.forename: Hishaam
authors.initials: H
authors.lastname: Ismael
authors.affiliation: The University of Texas Health Science Center at Tyler, Tyler, TX, USA.
authors.forename: Yury
authors.initials: Y
authors.lastname: Ragoza
authors.affiliation: The University of Texas Health Science Center at Tyler, Tyler, TX, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Harden
authors.affiliation: The University of Texas Health Science Center at Tyler, Tyler, TX, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Cox
keywords: Endometriosis; Spontaneous umbilical; Umbilical hernia; Umbilical reconstruction