Persistent Urachus in the Adult

Umbilical fistulas derived from remnants of the urachus are rare, particularly in adults. Four cases of pathologic conditions originating in the urachus, seen at the U. S. Marine Hospital, Staten Island, during the past five years are reported. One was a malignant growth, the other three cases were chronic fistulas. At birth the urachus reaches to the umbilicus. Normally, after birth the bladder descends, taking the urachus with it, leaving only a fibrous tissue cord. In the normal adult the urachus measures from 3 to 10 cm. in length and reaches only one third the distance from the apex of the bladder to the umbilicus, being attached at the umbilicus only by fibrous cords from the obliterated umbilical arteries. In a small percentage of cases, however, such descent of the urachus does not occur, and there remains a more or less obliterated epithelial structure reaching from the umbilicus to the