# Double Trouble: A Rare Clinical Presentation of Bladder and Umbilical Endometriosis

## TL;DR

A 42-year-old woman presented with rare bladder and umbilical endometriosis, confirmed through MRI and histopathology.

## Contribution

This is the first documented case of concurrent bladder and umbilical endometriosis.

## Key findings

- Cyclic hematuria and umbilical bleeding led to the discovery of bladder and umbilical endometriosis.
- MRI and cystoscopy confirmed the presence of endometrial lesions in both locations.
- Histopathology confirmed the diagnosis, highlighting the rarity of this condition.

## 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.