Persistent Urachal Patency Presenting as Umbilical Discharge: A Surgical Case Report

Patent urachus is a very rare congenital anomaly caused by failure of obliteration of the allantois, which generally reduces during fetal development to form the urachus. In humans, the urachus typically closes by the end of the first trimester and persists as the median umbilical ligament; failure of this process results in a persistent communication between the bladder and the umbilicus. This anomaly most commonly presents in the neonatal period with urinary leakage from the umbilicus and presentation beyond infancy is uncommon, often leading to diagnostic challenges. Urachal anomalies are classified into patent urachus, urachal sinus, urachal cyst and bladder diverticulum and early recognition with surgical excision is recommended to prevent recurrent infection and other complications. We report a significant case of patent urachus in a 15-year-old female who presented with a one-year history of intermittent discharge from the umbilicus and mild pain in the periumbilical region. Imaging, including USG and contrast-enhanced computed tomography, confirmed the presence of a patent urachus extending from the umbilicus to the dome of the urinary bladder. The patient underwent laparoscopic excision of the urachus, with absolute resolution of all postoperative symptoms. This case signifies the importance of considering patent urachus as a differential diagnosis of chronic umbilical discharge in older children and focuses the value of proper imaging and timely surgical intervention for achieving favourable outcomes.