An erythematous and draining umbilicus

Abstract

20-year-old man presented to the Emergency Departent (ED) with fever, abdominal pain, and yellowish ilky discharge of the umbilicus for 3 days. He noted the mbilicus draining straw-colored fluid about 1 week rior, and developed periumbilical erythema and tenderess. He had two other episodes of umbilical drainage ith fluid during the prior 3 months. He was quite ealthy before and denied history of recent abdominal njuries. The vital signs were: temperature of 38.2°C, a lood pressure of 143/83 mm Hg, a respiratory rate of 12 reaths/min, and a pulse rate of 100 beats/min. Physical xamination revealed an erythematous, swollen, and ildly everted umbilicus (Figure 1). The most tender rea was located about 2 cm below the umbilicus in the idline. Purulent discharge could be expressed manually ith infra-umbilical pressure towards the umbilicus. No uscle guarding or rebound tenderness of the abdomen as noted. Laboratory tests revealed increased leukocyte ount of 10.9 1000/mm with 83% neutrophils. Serum iochemistry tests and urinary dipstick test were normal. Sagittal midline ultrasound scan of the abdomen by an mergency physician revealed a hypoechoic complex eneath the umbilicus (Figure 2). The findings were ighly suggestive of an infected umbilical urachal sinus. road-spectrum antibiotic therapy with intravenous amicillin/sulbactam was administered. The symptoms of