Double Trouble - A Rare Clinical Presentation of Bladder and Umbilical Endometriosis

Sep 28, 2026

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Endometriosis is a common gynecologic condition in which tissue resembling the uterine lining grows outside the uterus, often affecting pelvic organs. Bladder involvement is uncommon, and concurrent bladder and umbilical endometriosis is exceptionally rare. A 42-year-old woman presented with cyclic hematuria and cyclic bleeding from the umbilicus. Initial evaluation did not yield a definitive diagnosis; MRI suggested an endometrial lesion and cystoscopy identified a polypoidal bladder mass. Histopathology confirmed endometriosis in both umbilicus and bladder, presenting a rare concurrent case with discussion of etiology, presentation, diagnosis, and management.

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CategoryHealthcare

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Abstract

Introduction

Case Presentation

How to cite this article

Review began 09/22/2025 Review ended 11/23/2025 Published 11/30/2025 © Copyright 2025 Palanisamy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98145 Open Access Case Report Double Trouble: A Rare Clinical Presentation of Bladder and Umbilical Endometriosis Venkateshen Palanisamy 1, Sushmitha Kothapalli 1 , Velmurugan Palaniyandi 1, Hariharasudhan Sekar Sriram Krishnamoorthy 1 1. Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND Corresponding author: Sriram Krishnamoorthy, [sriram.k@sriramachandra.edu.in](sriram.k@sriramachandra.edu.in) 1 , Abstract Endometriosis is a common condition among women where tissue resembling the uterine lining grows outside the uterus. This misplaced tissue can develop in several areas, including the peritoneum, pouch of Douglas, vagina, uterosacral ligaments, rectovaginal septum, rectosigmoid junction, bladder, and umbilicus. Although endometriosis most often affects the pelvic organs, cases involving the bladder are relatively rare. The exact cause of bladder endometriosis remains uncertain, and when it occurs alongside umbilical endometriosis (Villar 's nodule), it is considered an infrequent clinical presentation. We present a case report of a 42-year-old woman who presented with cyclic blood in her urine along with cyclic bleeding from her umbilicus. Her initial evaluation and examination did not provide a definitive diagnosis. An MRI of the abdomen and pelvis revealed a lesion in the umbilical area, which was suggestive of an endometrial growth. Further investigation with cystoscopy identified a polypoidal mass on the posterior bladder wall. The histopathological examination confirmed the presence of endometriosis in the umbilicus and bladder. This report presents the first documented instance of concurrent bladder and umbilical endometriosis, exploring the potential etiological factors, clinical presentation, diagnostic workup, and management options. Categories: Urology Keywords: bladder endometriosis, cyclical hematuria, cyclical umbilical bleeding, endometriosis, umbilical endometriosis Introduction Endometriosis is one of the common gynaecological conditions characterised by the presence of tissue that closely resembles the endometrial tissue outside the uterus. The most common presentation is pelvic pain and infertility. While endometriosis primarily affects pelvic structures such as the ovaries and fallopian tubes, with advancements in diagnostic laparoscopy and imaging techniques, we have identified many other extra-pelvic sites of occurrence. Endometriotic lesions have been found in various other organ systems, including the genitourinary tract, intestine, peritoneum, and, in rare instances, even the brain [1] . The definitive diagnosis of endometriosis is confirmed by histopathological analysis, which requires identification of endometrial glandular and stromal tissue outside the uterus. Although several non-invasive methods, such as imaging studies and serum biomarkers, have been explored to aid diagnosis, their sensitivity and specificity remain low. As a result, diagnosing endometriosis is often challenging. The most definitive way to confirm the condition is through the direct visualisation and biopsy of lesions during laparoscopy or laparotomy. One rare site of extra-pelvic endometriosis is umbilical endometriosis, also known as Villar 's nodule. This condition is rare and often results from iatrogenic seeding following previous uterine surgery. However, in some cases, umbilical endometriosis occurs without any history of prior abdominal surgery or uterine procedures, making it an even rarer phenomenon [2] . Patients with this condition may experience periodic pain, cyclic bleeding f

FAQs

Why is bladder endometriosis considered rare?

Bladder endometriosis is uncommon because endometriosis most often involves pelvic organs. Only a small proportion of women with endometriosis have bladder involvement.

What symptoms did the 42-year-old patient present with?

The patient had recurrent cyclical hematuria related to the menstrual cycle and cyclic bloody discharge/bleeding from the umbilicus for three months.

How was the diagnosis confirmed in this case?

MRI suggested an endometrial deposit in the umbilical region, and cystoscopy identified a polypoidal mass on the posterior bladder wall. Histopathological examination confirmed endometriosis in both sites.

Sep 28, 2026

Uploaded by Aldword