Presentation
Purulent umbilical discharge, tenderness, and local infection.
Patient Data
The sub-umbilical region displayed a well-defined midline collection with a thickened enhancing wall and air foci.
It is linked to the urinary bladder fundus through a cord-like soft tissue connection in the anterior abdominal wall, indicating a remnant of the urachus.
Case Discussion
The diagnosis is an infected urachal cyst with sinus formation. Congenital urachal anomalies are remnants of the urachus, which connect the urinary bladder to the umbilicus during embryonic life.
The spectrum includes:
patent urachus: a patent connection exists between the urinary bladder and the umbilical skin
sinus: a patent connection that is open towards the umbilical skin and closed at the urinary bladder end
cyst: a sub-umbilical loculated collection that is closed at both ends
diverticulum: a patent connection that is open towards the urinary bladder and closed at the umbilical end
The late presentation of our patient at 45 years old indicates that it was not patent or forming a sinus.
It was a neglected uncomplicated cyst that became infected, forming an abscess that breached the umbilical skin and created a sinus.
Management involves treating the infection, debriding, and resecting the cyst.
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