Infected Patent Urachus Presenting As Umbilical Discharge in an Adult: A Case Report

The urachus is an embryologic connection between the bladder and umbilicus that typically closes by the end of the first trimester. Failure of complete obliteration results in urachal anomalies, most commonly identified during infancy and rarely persisting into adulthood. Patent urachus in adults is exceedingly uncommon and may present with nonspecific symptoms, creating diagnostic challenges in the emergency department. We report a case of a 29-year-old male who presented with acute periumbilical abdominal pain and purulent umbilical discharge. Physical examination demonstrated periumbilical tenderness, erythema, and active drainage without systemic signs of infection. Laboratory evaluation was unremarkable. Computed tomography of the abdomen and pelvis with contrast revealed a thick-walled patent urachus extending from the umbilicus to the bladder dome with surrounding inflammatory changes, consistent with superimposed infection. The patient was managed conservatively with oral amoxicillin-clavulanate, analgesia, and outpatient urology follow-up for consideration of definitive surgical excision. His symptoms improved, and he was discharged in stable condition. This case highlights the importance of maintaining a high index of suspicion for urachal pathology in young adults presenting with umbilical discharge and abdominal pain. Early recognition and appropriate imaging are essential to avoid misdiagnosis, guide management, and prevent complications such as recurrent infection or malignant transformation.