Umbilical Drainage in a Young Adult: Presentation and Management of an Infected Urachal Remnant

Urachal remnants are rare congenital anomalies that typically regress in early childhood, infrequently encountered in adults. When symptomatic, infection is the most common presentation and may mimic more common causes of abdominal pathology, leading to delayed diagnosis. We report the case of a 20-year-old male who presented with abdominal pain and purulent umbilical discharge that failed outpatient antibiotic therapy. Computed tomography (CT) demonstrated subcutaneous collections with calcified material concerning for an infected urachal remnant, confirmed on CT cystogram, requiring incision and drainage with drain placement, followed by planned definitive surgical excision. Because of the infrequent nature of adult urachal remnants, they may be underrecognized at initial presentation. CT is essential for diagnosis and operative planning, as parenteral antibiotics and drainage are the mainstay of treatment for acute infection, with delayed definitive excision, and are key to optimal outcomes and recurrence prevention.