A child complains of fluid coming out of umbilicus on straining. What is the diagnosis?

Ans. a. Urachal fistula (Ref: Nelson 19/e p651; Bailey 26/e 968. 25/e p986)Diagnosis in a child complaining of fluid coming out of umbilicus on straining is urachal fistula.'A persistent urachus (urachal cyst) is due to failure of closure of the allantoic duct and is associated with bladder outlet obstruction. Patency should be suspected if a clear, light yellow, urine-like fluid is being discharged from the umbilicus. - Nelson 19/e p651Patent urachusA patent urachus seldom reveals itself until maturity or even old ageQ.This is because the contractions of the bladder commence at the apex of the organ and pass towards the baseQ.Because it opens into the apex of the bladder a patent urachus is closed temporarily during micturition and so the potential urinary stream from the bladder is cut off.Thus, the Astula remains unobtrusive until a time when the organ is overfull, usually due to some form of obstructionQ.Treatment:Remove the obstructionQ in the lower urinary tract.If the leak continues or a cyst develops in connection with the urachus: Umbilectomy and excision of the urachusQ