An Unusual Midline Venous Collateral along the Median Umbilical Fold: Computed Tomography Findings of a Retropubic Venous Plexus Variant

We describe a previously unreported venous anatomical variation identified on contrast-enhanced abdominal computed tomography performed for evaluation of abdominal pain in a young male. Imaging demonstrated a 3-mm enhancing venous collateral originating from the lower retropubic (vesical) venous plexus, traversing the retzius space, and ascending cranially along the median umbilical fold toward the umbilicus, with small tributaries connecting to the anterior abdominal wall veins. No associated pelvic venous congestion, mass lesion, or urachal abnormality was identified. This rare variant highlights that venous structures arising from the retropubic venous plexus may course superiorly along the median umbilical fold – an area where veins are not typically expected – underscoring the importance of recognizing this anatomy to avoid imaging misinterpretation and to prevent inadvertent vascular injury during retropubic, suprapubic, or ventral midline surgical procedures.