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.
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.)
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.
This finding should prompt a careful search for other urogenital anomalies.
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.)
Urachal Cyst—CT. Urachal cyst confirmed by contrast-enhanced CT scan of the abdomen/pelvis. (Photo contributor: Martin D. Klinkhammer, MD, MPH.)