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Belly button mystery

February 22, 2015 1 Comment

Here’s a really nice case from Dr. Michael Garner.

A healthy 17 yo male presents with a 1st episode of peri-umbilical progressive pain for the past 3 days.  No nausea or vomiting; Normal stool; Unconfirmed fever.  Slight discharge from umbilicus for last 24 hours.
Referred by clinic to R/O incarcerated hernia.
Examination of the abdomen demonstrated peri-umbilical redness and pain. No mass. No guarding or rebound.
urachal cyst1urachal cyst2
Naturally point of care ultrasound is applied.
urachal cyst3
urachal cyst4
So what’s the diagnosis?
 Hint: Remember your embryology!
If you answered infected urachal cyst and your name is Brett, then you get to say “Check out the big brain on Brett” after which you should go and watch Pulp Fiction a few more times while pretending you are as cool as Samuel L. Jackson.
urachal cyst 5
Urachal cysts are most commonly found in the pediatric population as the urachus usually regresses in early infancy.  Infected cysts are the most common presentation of urachal abnormalities in adults.  They carry a risk of malignant transformation if not removed.  Treatment usually includes drainage of the cyst with a course of antibiotics followed by later surgical excision of the urachal remnant.
Here’s a nice review article by Ekwueme and Parr:
Filed in: Rogue waves

Comments (1)

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  1. Peter says:

    Very helpful. Thanks!

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