Umbilical-urachal sinus with preperitoneal abscess

📄 SCRS

Umbilical-Urachal
Sinus with Abscess

Congenital urachal remnant with preperitoneal abscess formation

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Reporting Panel

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Abdominal wall Pathology

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Case Study

USG

Clinical History

A 23-year-old male presented with intermittent umbilical discharge and mild abdominal discomfort for the past few weeks. The discharge was mucoid to purulent in nature and occasionally foul-smelling. No significant fever or systemic symptoms were noted. No history of trauma, recent surgery, or urinary symptoms. On examination, the umbilicus showed mild erythema and seropurulent discharge. Suspected urachal sinus. Ultrasound was advised for further evaluation.

Ultrasound Findings

Ultrasound shows a heterogeneous collection measuring approximately 17 × 19 mm in the preperitoneal plane of the anterior abdominal wall, in the midline, just below the level of the umbilicus and posterior to the linea alba. Multiple internal air pockets are seen, suggestive of abscess formation. Mild surrounding soft tissue echogenicity is noted, suggestive of local inflammation. The abscess is seen communicating with the umbilicus through a sinus tract measuring approximately 5.8 mm. Minimal collection with inflammatory changes is present. No evidence of communication with the urinary bladder is seen. No evidence of intraperitoneal extension of abscess is identified.

Impression

Features are suggestive of an infected umbilical-urachal sinus with preperitoneal abscess formation.

Key Learning Points

• Umbilical-urachal sinus is due to incomplete obliteration of the urachus.
• It forms a blind-ending tract from the umbilicus without bladder communication.
• Infection may produce a preperitoneal abscess in the lower anterior abdominal wall.
• Umbilical discharge is an important clinical clue.
• Ultrasound can demonstrate the sinus tract and associated collection.
• Abscess may show heterogeneous echoes, internal debris, and air pockets.
• CT abdomen is useful to define extent and exclude bladder or intraperitoneal communication.

Recommendation

CT abdomen follow-up is advised for further evaluation of extent, confirmation of the sinus tract, and surgical planning. Clinical correlation and surgical consultation are recommended, especially if persistent discharge, recurrent infection, or abscess enlargement is present.