Bleeding from the umbilicus

A 41 year old female, para 1+1 with a background history of type2 DM, Htn and a previous uneventful Caesarean section in 2008. She was subfertile since then. She presented with scanty painless bleeding from the umbilicus for past 5 months which coincided with her menses. The bleed would start a few days before her menses and ceased by day two, in small amount and painless. Her cycles were regular with normal flow and no dysmenorrhea. She also noted blackish discoloration of the umbilicus. There was no other abnormal bleeding. On examination, there was an umbilical nodule with dusky blue discoloration with minimal bleeding, no other palpable abdominal mass. Vaginal examination was unremarkable. What should be the next step?

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Umbilical endometriosis or ectopic endometriosis
Ectopic Endometriosis
Needs further investigation and evaluation like USG or MRI to conclude and treatment plan.
Thanks Dr Pushkar Bhomia
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Subfertility/infertility is due to postcaesarian umbilical endometriosis and blackish discoloration is due to decomposition of blood during cyclic bleeding. Infertility will be due to fallopian tube blocking due to endometriosis. Umbilical endometriosis can be treated by surgical excision of mass. Sterility needs further investigations and treatment plan
It may be due to cutaneous endometriosis or due to spillage of endometrium in abdomen during caeserian section. Now this endometrium response with menstrual cycle with bleeding. Secondary infertility may be due to bloakage of tubes as postoperative complication or due to endometriosis.
Umbilical endometriosis USG abdomen, Biopsy needed . May be due to spillage of endometrium into peritoneum during CS. Contraceptive pills, GnRh antagonists, progestegen can be tried . SURGICAL exploration and excision of endometrial tissue should be done .
Umbilical endometriosis caused by ectopic endometrial tissue Treatment is surgical exploration and excision of tissue is definitive treatment
IT'S A..CASE OF.. ? PRIMARY CUTANEOUS ENDOMETRIOSIS.. NEED'S.. USG STUDY FOR CONFIRMATION AND MANAGEMENT..
Tnx Dr Ashok Leel sir
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Umblical endometriosis Get an MRI done for further extension Surgical excision is treatment of choice
Endometriosis involving umbilical skin Adv Surgical excision and histology of specimen
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