Persistent Umbilical Abscess with Delayed Healing

Case at a Glance

A 25-year-old female presents with a persistent umbilical abscess that has failed to heal completely over three weeks despite antibiotic treatment, characterized by recurrent bleeding and drainage.

Patient's Story

The patient initially developed bleeding and purulent discharge from her umbilical area in late June while traveling. She sought medical attention at an urgent care facility two days after symptom onset, where she was diagnosed with a ruptured umbilical abscess. She was prescribed oral Bactrim and topical antibiotic cream for one week. While the purulent discharge resolved, intermittent drainage persisted. Despite two follow-up visits with her primary care physician, the wound continues to reopen with minimal physical activity such as bending. The patient has a history of previous umbilical growth removal but notes this current condition is distinctly different.

Initial Assessment

Physical examination revealed an umbilical lesion with purulent discharge and surrounding erythema. Initial diagnosis was umbilical abscess with spontaneous rupture. Laboratory studies and imaging were not performed at initial presentation.

The Diagnostic Journey

The patient received standard antibiotic therapy with some initial improvement in purulent discharge. However, subsequent evaluations showed persistent bleeding and failure of wound epithelialization. A scab formation was noted approximately three weeks post-initial treatment, but wound dehiscence occurred within hours. The surrounding tissue demonstrated purplish discoloration, and the patient developed contact dermatitis from adhesive bandages.

Final Diagnosis

Chronic umbilical abscess with delayed wound healing, possibly complicated by underlying anatomical factors or resistant bacterial infection.

Treatment Plan

Initial treatment included oral sulfamethoxazole-trimethoprim and topical antibiotic therapy. Given the persistent nature and failure to heal, referral to general surgery is recommended for further evaluation and possible surgical intervention. Consider wound culture and sensitivity testing to guide targeted antibiotic therapy.

Outcome and Follow-up

Patient continues to experience recurrent wound dehiscence after three weeks of conservative management. The wound demonstrates minimal pain but persistent bleeding with minor physical activity. Surgical consultation is pending for definitive management of this refractory umbilical lesion.