A Case of Patent Urachus Masquerading as Chronic Umbilical Abscess

We report a case of urachal sinus presenting as recurrent umbilical abscess in a male who presented with complaints of umbilical mass with pus discharge. Umbilicus is potentially a weak part in the anterior abdominal wall. Embryologically it represents neck of the bottle which consists of umbilical vessels, structures related to digestive and urinary system. A 30 years young male with normal secondary sexual characters came to the outpatient department with the complaints of pus discharge, swelling near umbilicus. He underwent clinical and radiological evaluations. While a localised collection was detected by ultrasound close to the umbilicus, a communication was detected by CT scan in a fibrous strand-like structure that extended from the umbilicus to the bladder by about 10 cm.

An open exploration was done under regional anaesthesia and 20 ml of abscess drained with excision of tract by ligating near the bladder end and primary closure was done. Without any recurrence, the postoperative period went without incident. Adults must have a high index of suspicion when it comes to urachal anomalies in order to act quickly and achieve better results with lower morbidity. Atypical presentations of urachal anamolies frequently lead to incorrect diagnoses. Its evaluation in adults is a difficult task due to the absence of typical clinical and radiological findings as well as clear-cut guidelines.