To establish the proper approach and management of an urachal anomaly in children.

We retrospectively reviewed the medical records and imaging studies of 33 children (21 boys, 12 girls) treated for an urachal anomaly over a ten-year period.

Twenty-four patients were equally diagnosed with either an urachal sinus or urachal cyst; the other nine patients were confirmed to have a patent urachus. Umbilical discharge (14 patients) and umbilical granuloma (9 patients) were the most common presentations. The 12 patients with an urachal sinus underwent ultrasonography (USG) (10; diagnostic), 2 fistulography (all; diagnostic). Those with an urachal cyst underwent either USG (6/12; diagnostic), computed tomography (CT) (3; diagnostic), fistulography (2; diagnostic), or magnetic resonance imaging (MRI) (1; diagnostic). One subject was affected by acute appendicitis, which was confirmed by CT. Of the 9 children with patent urachus, 7 underwent USG (all; diagnostic); exploration without further imaging studies was performed on the remaining 2 subjects. Surgical excision was performed in 30 patients. Omphalomesenteric duct or Meckel's diverticulum were incidental findings, which were simultaneously repaired. Conservative treatment was successful in only 3 patients.

Urachal anomalies in children mainly manifest as umbilical discharges and umbilical granuloma, but may present non-specific symptoms in some cases. USG is a useful method for diagnosis, but other imaging modalities can be useful to establish the differential diagnosis. A limited number of children with urachal anomalies, mainly presenting with an umbilical discharge, can be managed conservatively. However, complete surgical excision of the lesion, with the possible associated anomalies, should be the basic scheme for children with urachal anomalies.