Persistent umbilical discharge beyond the neonatal period due to patent urachus in an infant managed in a resource-limited setting: a case report

Introduction and importance: Patent urachus is a rare congenital anomaly resulting from failed obliteration of the embryonic urachus. The educational value of this report lies in showing a pragmatic diagnostic and surgical pathway for a symptomatic infant in a resource-limited setting where ultrasonography, fistulography, and MRI were unavailable. Case presentation: A 2-month-old male infant presented with a 3-week history of persistent umbilical discharge and intermittent fever. Examination showed a small patent umbilical opening with continuous seropurulent discharge and mild peri-umbilical erythema. Laboratory tests showed leukocytosis and elevated C-reactive protein. Plain abdominal radiography was obtained primarily to exclude bowel obstruction, pneumoperitoneum, and other intra-abdominal pathology; it also showed a nonspecific midline soft-tissue density extending from the bladder region toward the umbilicus, which supported – but did not establish – the clinical suspicion of patent urachus. Because ultrasonography and MRI were unavailable, diagnosis rested on the characteristic clinical picture and was confirmed intraoperatively. Following initial intravenous antibiotics, the urachal tract was excised en bloc with a small bladder cuff, and the bladder was repaired in two layers. A transurethral Foley catheter was left in place for 48 hours. Recovery was uneventful. Clinical discussion: Persistent umbilical discharge beyond the neonatal period warrants assessment for congenital remnants, particularly patent urachus and omphalomesenteric duct anomalies, in addition to omphalitis and umbilical granuloma. In symptomatic infected lesions, early infection control followed by definitive excision offers cure and prevents recurrence. This case emphasizes that, in low-resource settings, careful clinical evaluation and timely surgery may compensate when advanced imaging is not immediately available. Conclusion: Patent urachus should be considered as an important differential diagnosis in infants with persistent umbilical discharge. Clear description of the diagnostic pathway, explicit acknowledgment of imaging limitations, and definitive surgery after infection control can achieve excellent outcomes even in resource-constrained practice.