Infected urachal sinus with de novo stone and peritonism in a young athlete adult: A case report

INTRODUCTION AND IMPORTANCE: Urachal cyst (UC) sinus occur secondary failed regression of allantois's embryonal canal during fetal development. Several types depending on the arrest level and connection to the urogenital tract. Umbilical urachal sinus is characterized in less than 15 % of cases. An infected urachal sinus patient can present with umbilical sinus and purulent discharge with various emergency presentations and scenarios. CASE PRESENTATION: A 26-year-old Sudanese male, a healthy athlete, presented two weeks before the last presentation with periumbilical discomfort, and umbilical discharge increased with physical activity. He was first seen in the outpatient clinic and diagnosed with an uncomplicated umbilical cyst. One week later, periumbilical pain became throbbing, severe with a dragging sensation, and skin erythema. His swelling produced purulent discharge with concomitant low-grade fever. He denied any past medical, surgical, or family history. An ultrasound scan revealed a periumbilical cyst confirmed by CECT consistent with an infected urachal sinus. Surgical excision of the cyst and umbilicoplasty was achieved with an uneventful postoperative course. CLINICAL DISCUSSION: Urachal sinuses may vary in their presentation according to the anomaly and clinical effect. It can be daunting to diagnose, even with the availability of CECT modalities. Conservative management can be of benefit in case of incidental findings, but surgical management is the preferred approach for complicated patients. A laparoscopic approach is the recommended treatment. CONCLUSION: Our case report shows that serious complications can be prevented with early diagnosis, management, and prompt surgical intervention if this rare diagnosis is kept in mind.