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7-22: Patent Urachal Duct

Kevin S. Barlotta; Lawrence B. Stack; Kevin J. Knoop

Clinical Summary

When the vestigial urachal duct is not obliterated during development, drainage can occur from the bladder to the umbilicus. Urachal cysts may also be present, detectable as a painful mass between the umbilicus and pubis when they become infected or by ultrasound. Rarely, adenocarcinoma may form in these remnants.

FIGURE 7.64

Patent Urachal Duct. This 19-year-old man presented to the emergency department with clear fluid (urine) draining from the umbilicus, suggestive of a patent urachal duct. (Photo contributor: Kevin J. Knoop, MD, MS.)

In a patient with a Patent Urachal Duct, the umbilical area has a dark red swelling with white swirls. There is drainage in the area around the duct.
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Management and Disposition

Acute treatment is usually not required unless an infection is evident. Routine urologic consultation for surgical revision is indicated. A retrograde study with radiopaque dye will outline the patent duct.

Pearl

  1. This finding should prompt a careful search for other urogenital anomalies.

FIGURE 7.65

Urachal Cyst. Umbilical pain and discoloration suggested an umbilical mass or inflammation, prompting a CT scan that revealed a urachal cyst. (Photo contributor: Martin D. Klinkhammer, MD, MPH.)

In a patient with an Urachal Cyst, there is black discoloration of the navel area and a slight swelling.
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FIGURE 7.66

Urachal Cyst—CT. Urachal cyst confirmed by contrast-enhanced CT scan of the abdomen/pelvis. (Photo contributor: Martin D. Klinkhammer, MD, MPH.)

In a C T scan of the abdominal organs, an Urachal Cyst is shown as a round, black area with a white center.
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