A rare case of urachus anomaly in an adult

Abstract

The urachus is a fibrous remnant connecting the urinary bladder to the umbilicus, and its anomalies are rare in adults, often remaining asymptomatic until infected. Infected remnants, such as a urachal sinus, can present with variable clinical features, including purulent umbilical discharge. We report a case of an infected urachal sinus in a 64-year-old male, known to have uncontrolled diabetes, who presented with a one-month history of copious purulent umbilical discharge, lower abdominal distension on, and recurrent fever. Physical examination revealed an everted, erythematous umbilicus with a discharging ulcer. Imaging with CECT abdomen was diagnostic, showing an ill-defined, peripherally enhancing tract, approximately 9 cm in length, connecting the umbilicus to the dome of the urinary bladder. Definitive management was achieved via laparotomy and complete surgical excision of the infected urachal tract. Urachal remnant infection should be strongly considered in the differential diagnosis for adults presenting with purulent umbilical drainage, particularly in immunocompromised patients like those with diabetes. A high index of suspicion, combined with appropriate imaging, leads to timely diagnosis and definitive treatment, consisting of surgical excision following antimicrobial therapy.