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malignant transformation, although the true incidence of this complication
remains unknown. Patients with urachal anomalies are also at higher risk for
additional genitourinary anomalies, particularly vesicoureteral reflux (VUR),
which can be further evaluated as an outpatient.
Omphalomesenteric Duct Remnants
Omphalomesenteric duct remnants also can present at any age. In the neonatal
period these usually present with persistent discharge from the umbilicus or
stump—the discharge may be clear or bilious. Because omphalomesenteric duct
remnants typically are composed of gastric mucosa, the discharge is often acidic
and can cause local dermatitis. It can also be confirmed by US, and is treated by
surgical excision.

Abnormal Stool
Goals of Treatment
The goal of treatment is to distinguish between benign variations in stool
frequency or color and changes that require urgent evaluation. In the first month
of life, infant stool varies from thick, dark meconium, to green-colored
transitional stool, and eventually yellow, seedy breast-milk stool. Texture may
vary from thick, paste-like stool to a much looser stool. These variations may be
worrisome to a new parent, but rarely reflect any pathology in the infant. This is
in contrast to bloody or acholic stools, as well as chronic watery diarrhea, all of
which require a much more detailed evaluation.
CLINICAL PEARLS AND PITFALLS
Bloody stool is a nonspecific finding that may be benign or lifethreatening in nature.
Acholic stool in a neonate may represent biliary atresia, a condition that
requires urgent diagnosis and intervention and may not present until
several weeks of life.
Hematochezia and Melena
Bloody stool in infants can be relatively benign, caused by anorectal fissures,
swallowed blood from cracked nipples, or a food-protein allergy. In more severe
cases, it can represent life-threatening intestinal ischemia and necrosis, as in

volvulus or enterocolitis. Detailed history and physical examination is necessary
to distinguish benign and worrisome causes of GI bleeding, including feeding and