Bowel Ischemia: A Life‐Threatening Complication of an Infected Urachal Cyst in an Adolescent

While infection is a recognized complication of congenital urachal cysts, progression to an inflammatory phlegmon causing bowel ischemia is an exceptionally rare and life‐threatening event in the pediatric population. We report the case of a 14‐year‐old male with a 7‐year history of an infraumbilical mass who presented with an acute abdomen. Contrast‐enhanced computed tomography revealed a 7.1 cm urachal phlegmon with a central necrotic core and dense adherence to the adjacent ileum. Exploratory laparotomy confirmed irreversible segmental small bowel ischemia, necessitating en‐bloc excision of the urachal remnant and the affected 12 cm ileal segment with a primary anastomosis. Histopathology confirmed a benign infected cyst with associated transmural bowel necrosis. This case highlights that long‐standing urachal anomalies can evolve into aggressive inflammatory masses capable of precipitating visceral compromise. It underscores the importance of a high index of suspicion for rare complications and supports the consideration of definitive surgical excision for symptomatic remnants to mitigate the risk of severe morbidity.