Urine appears to be passing from the umbilicus in a full-term newborn; which condition would you suspect?

• A. Exstrophy of the bladder
• B. Umbilical hernia
• C. Meconium fistula
• D. Patent urachus

Answer: (D)

When urine is seen draining from the umbilicus in a newborn, think of a patent urachus. The urachus is a channel that connects the bladder to the umbilicus during fetal development and normally becomes a fibrous cord after birth. If it fails to close, urine can pass from the bladder through this connection and discharge at the umbilicus.

This presentation—continuous or intermittent urinous drainage from the umbilicus, often more noticeable with crying or urination—points to a patent urachus. It differs from other neonatal issues: an exstrophy of the bladder would show the bladder exposed on the abdominal wall; an umbilical hernia involves protruding abdominal contents at the umbilicus without urinary leakage; a meconium fistula would discharge meconium, not urine.

Management involves confirming the diagnosis and planning definitive repair to close the urachal tract, typically with surgical or planned corrective intervention, while addressing skin irritation from ongoing drainage in the interim.