Abstract
Umbilical discharge in adults is a rare presentation in primary care and is frequently misdiagnosed as superficial infections, umbilical dermatitis, or abscesses, particularly in individuals with known predisposing factors such as obesity, poor hygiene, or diabetes mellitus. However, in the absence of these risk factors, the possibility of underlying congenital anomalies such as a patent urachus should be considered, as prompt recognition and diagnosis are paramount to prevent complications such as recurrent infections, abscess formation, and even malignant transformation. We report the case of a 29-year-old healthy male who presented to a primary care clinic with a 5-day history of purulent umbilical discharge and abdominal pain without associated fever or systemic symptoms. Physical examination revealed mild periumbilical erythema and purulent discharge but no palpable mass. The absence of typical risk factors for superficial infection raised clinical suspicion of an underlying pathology. Early diagnostic workup with ultrasound revealed a hypoechoic collection within the subcutaneous tissues, and subsequent contrast-enhanced computed tomography (CT) confirmed an infected umbilical urachal sinus. The patient was promptly referred to a surgical team for inpatient management. He was commenced on intravenous amoxicillin-clavulanic acid and underwent an incision and drainage for the infected umbilical urachal sinus. He made an uneventful recovery and was arranged for an elective laparoscopic excision of the urachal remnant. This case highlights several important learning points. In adults, urachal anomalies are rare and frequently misdiagnosed as superficial infections or abscesses, especially in the context of comorbidities such as diabetes and obesity. This case highlights the importance of maintaining a broad differential diagnosis, including rare congenital conditions such as a patent urachal sinus, when assessing adults presenting with umbilical discharge. It also illustrates the critical role of primary care providers in recognizing uncommon conditions, as timely recognition and diagnosis are essential for the effective management of this rare but potentially serious condition.