Presentation
Complaining of difficulty in micturition for 6 days burning, micturition for 5 days, pain in the mid-abdomen around umbilicus for 6 days. On examination, fever was present. There was no visible swelling over abdomen. Tenderness was present over lower abdomen in umbilical and infraumbilical regions .
Patient Data
A linear hypoechoic track is seen extending from the umbilicus to the dome of the bladder. The urinary bladder shows settled echogenic sludge within thickened walls suggestive of cystitis.
The findings are consistent with a patent urachus with signs of infection and cystitis.
Case Discussion
Embryologically, the urachus is a fibrous band extending from the umbilicus to the anterio- superior end of the bladder. It is the vestigial part of cloaca and allantois (a yolk sac derivative). At birth or early life, the urachus involutes and obliterates and become the vestigial median umbilical ligament.
Patent urachuses are more common in children. However, its presentation in adults is rare. The most common presention is discharge from the umbilicus but the most alarming symptom is lower abdominal pain and fever with chills. In adults, on imaging, a patient urachus is hypoechoic band between the urinary bladder and umbilicus. Overdistended urinary bladder, prominence of bilateral pelvicalyceal system and ureter are the assocuated findings in adults. Surgical excision is recommended treatment of choice.
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