Bowel Ischemia: A Life-Threatening Complication of an Infected Urachal Cyst in an Adolescent.

While infection is a recognized complication of congenital urachal cysts, progression to an inflammatory phlegmon causing bowel ischemia is an exceptionally rare and life-threatening event in the pediatric population. We report the case of a 14-year-old male with a 7-year history of an infraumbilical mass who presented with an acute abdomen. Contrast-enhanced computed tomography revealed a 7.1 cm urachal phlegmon with a central necrotic core and dense adherence to the adjacent ileum. Exploratory laparotomy confirmed irreversible segmental small bowel ischemia, necessitating en-bloc excision of the urachal remnant and the affected 12 cm ileal segment with a primary anastomosis. Histopathology confirmed a benign infected cyst with associated transmural bowel necrosis. This case highlights that long-standing urachal anomalies can evolve into aggressive inflammatory masses capable of precipitating visceral compromise. It underscores the importance of a high index of suspicion for rare complications and supports the consideration of definitive surgical excision for symptomatic remnants to mitigate the risk of severe morbidity.