Yellow discharge drained from a 21-year-old man's belly button for two days before he sought medical attention. When he came into the emergency department, the skin around his navel was red and splotchy.
During a physical exam, doctors found that the young man's abdomen was tender to the touch around his belly button. He did not take any medications and denied drug or alcohol use. Other than the unusual drainage, the young man was healthy.
Yet this wasn't the first time the patient had had fluid leak from his belly button. A similar situation had driven the young man to seek medical help a year earlier. At that time, he was diagnosed with a skin infection. Belly button infections are fairly common, but most occur in people with piercings, which the patient did not have. He was prescribed antibiotics, and his symptoms were resolved.
During his second visit to the ER, the patient noted that since childhood he sometimes felt what he described as a "pulling sensation" in his belly button and bladder area, particularly when he urinated.
"Since he was young, he always had some sort of discomfort or pain at times when had had to go to the bathroom," said his mother, who came to the ER with him. "He would feel this pulling sensation sort of from his belly button to his bladder."
Over the years, the patient had visited multiple specialists about the tugging feeling, but none of the doctors could identify the cause.
His mother had scoured the internet looking for answers to her son's unusual belly button puzzle. So she asked the ER doctors whether the pulling feeling her son described could come from a remaining part of his umbilical cord.
His doctors said it was very rare, but possible.
Doctors ordered a CAT scan of the patient's abdomen and pelvis. Based on his mother's questions, doctors asked the radiologist to focus in on the area between the patient's belly button and his bladder. Given how unusual the condition is, doctors had to direct the technician where to look.
The scan revealed an urachal remnant, a string of tissue that tethered the young man's bladder to his belly button. He had retained a structure called the urachus from gestation. The urachus is a channel that connects a fetus' bladder to its belly button. During the first trimester of pregnancy, the channel drains the developing baby's urine. The passage usually seals off around the 12th week of gestation and typically disintegrates at birth. The condition presents more often in men than women.
An urachal remnant is rare. Most doctors never see a case in the clinic because many patients do not develop symptoms and the condition is only discovered during an autopsy. Instead, the condition is usually something doctors just read about in medical school. In fact, this young man's case was published in the journal Case Reports in Emergency Medicine.
For patients with urachal remnants, the most common complication is infection. In some patients, the channel does not seal off; in others, cysts can form. Either complication may lead to sepsis, a life-threatening condition that occurs when the body's immune system overreacts to an infection. Cancer can also develop in the urachal remnant. The young man fortunately did not develop any of those complications.
The patient was put on antibiotics to clear his infection and referred to an urologist. In an outpatient procedure, surgeons removed the remnant laparoscopically.
Alan Lucerna, D.O., is the assistant director for the emergency department at Jefferson Stratford Hospital. James Espinosa is an attending physician in the emergency department at Jefferson Stratford Hospital and associate professor at Rowan University.