Discharge from umbilicus has not stopped even after taking antibiotics. Why?

Hi doctor,

Last month first, I noticed a tiny amount of clear fluid from the belly button. I took a shower and scratched the umbilicus, which later caused bleeding and pain. I took Keflex for three days, and it did not help. I went to emergency care. They did an ultrasound of the abdomen and wound culture swab. The US showed mild edema and no fistula or abscess. They changed to Doxycycline. A few days later, the culture showed Proteus Mirabilis. They switched to Bactrim-DS. I took it for two weeks. Pain reduced and discharge reduced too. But pain is still there, and some little discharge sometimes.

I did a CT scan of the abdomen this month first. It did not show any fistula or abscess, just local skin thickening in the umbilicus and trace mild complex fluid in the umbilicus. I have attached CT and US reports. The primary care doctor referred to a surgeon. He is saying a CT scan cannot see a cyst or fistula. He says he suspects a urachal cyst that ruptured. He wants to do exploratory surgery. I do not understand how a CT scan with and without contrast and with oral barium contrast miss fistula or cyst? Every medical case report regarding urachal cyst says CT is the gold standard in detecting cyst. He referred me to urology, but the next appointment is a week later, so I need some answers to ease my anxiety. I have panic attacks, and I do not want to undergo surgical exploration. I need to know that what I am dealing with and the treatment. This is what I think. Please help me understand my situation better. I think I had a cellulitis infection of the umbilical skin around the belly button. That caused the focal skin to thicken. And the infection is gone now, but inflammation is still there, and since the umbilicus area heals very slowly, it is taking time to heal. Other than pain and some discharge, I never had a fever or any systemic symptoms. So if my CT scan and US do not show any fistula or abscess, then I certainly dont have it. My symptoms match with the CT and US findings. The pain only happens around the skin of the umbilicus. If I try to clean the umbilicus, the pain increases, and it bleeds, making me think it is superficial. I have not touched the belly button in three days, and the pain and bleeding have stopped significantly. Also, whenever I get constipated or bloated after a heavy meal, I get pain in the umbilicus skin, and it bleeds, but that also has reduced significantly. The surgeon said since my wound culture showed Proteus Mirabilis, it means I have some communication between bladder and umbilicus which does not make sense because P. Mirabilis does not live in the bladder because if it did, then it would cause UTI, which I never had. Kindly give your opinion.

Hi doctor,

Thank you.

I have completed the Bactrim-DS course. I took it for two weeks. The pain subsided significantly but is still there in the circumference of the umbilicus. I do not want to do any surgery. If CT and US did not find any urachal remnant or anomaly, I do not understand the surgeon's intentions to do exploratory surgery. My issue is that there is still a pain in the umbilicus only when it shakes during walking or when I press on it. The pain appears to be superficial. I have not touched the umbilicus for three days, and the pain and bleeding have lessened a lot. I notice whenever I shower then pain and bleeding increase. If I use an antiseptic like Benzalkonium Chloride, the pain increases, and it later bleeds a tiny drop. The bleeding has never been more than a tiny drop of blood ranging from pink to bright red.

My questions are, can I dip a Q-tip in a bowl of soap water and clean the belly button daily? I dont want to shower since I think the pressure of the shower is making it bleed more, since pain and bleeding are reducing, that means it is healing, right, and based on all my tests, such as CT and US, and my description of symptoms, what do you think I am dealing with here? And what should the treatment be? Should I ask for another wound culture and take another round of antibiotics to completely eradicate the tiny hypodense complex fluid of about 1 ml volume found in the umbilicus in the CT scan?

Kindly give your opinion.

Hi doctor,

Thank you

I will suggest a sinogram to my urologist when I see him. Are such sinus not seen on an abdominal CT scan with and without contrast? If there is a sinus in the umbilicus, then the treatment is excision, right? How is the surgery usually performed? Will it be laparoscopic and minimally invasive? Will it be a simple or complicated surgery? Will it be under general or local anesthesia? Will they go inside the peritoneum? I am really worried about this surgery. Since I am not on antibiotics anymore and there is still a tiny amount of blood coming out of my belly button sometimes, Am I at risk for any infection? Also, I read that there is a risk of getting a rheumatic fever in untreated strep throat since the antibodies created by the body accidentally attack the heart valves. Is there any such risk in my condition? I have no fever or anything, and my pain has substantially reduced. Please give your advice.