Eight-day-old infant whose parents consulted for a poorly healed umbilicus. Personal history: first child born to healthy parents. Born at 39 weeks of gestation by euthecological delivery; Apgar 9/10, weight 2830 grams. No history of interest was reported, nor was the hospital report provided.
Examination revealed a wide implantation of the umbilical cord, which had a mucous appearance, and a small tear at the base of the cord, with no signs of local infection. The rest of the physical examination was normal. She reported no accompanying clinical manifestations. Silver nitrate was applied and an appointment was made for a check-up in 48 hours.
At the follow-up visit, she was given a discharge report after birth. It shows that the umbilical cord had a cyst, diagnosed in the second trimester prenatal ultrasound and described as a Wharton's jelly cyst measuring 49 x 39 mm. At birth she was assessed by a surgeon, who placed a clamp proximal to the cyst, which was resected. At two days of life, an abdominal ultrasound was performed, which was normal. During admission she remained asymptomatic and was discharged with normal clinical symptoms, except for a small tear at the base of the cord, which did not present complications.
At the outpatient follow-up visit, an abundant discharge of clear fluid from the centre of the umbilicus was observed, with no signs of infection. She was referred for assessment by paediatric surgery. The surgeon ligated the umbilical cord, which was almost detached and appeared moist. A fistulous tract was found to be present. A new abdominal ultrasound revealed a tortuous tubular structure communicating with the upper bladder wall and a diagnosis of persistent urachus (permeable urachus type) was made and observation and subsequent re-evaluation was decided. At eight months of life, spontaneous closure had occurred, and subsequent check-ups revealed the absence of urachal stricture.
