IntroductionThe urachus is a vestigial embryologic structure resulting from the obliteration of the allantois, which connects the fetal bladder to the umbilicus [1]. Failure of this canal to completely involute after birth leads to a spectrum of urachal anomalies, including patent urachus, sinus, diverticulum, and cyst, with the cystic form being the most common variant [2]. Urachal cysts are typically located in the extraperitoneal space between the bladder dome and the umbilicus and often remain clinically silent throughout childhood [1, 3].The most frequent complication that renders these anomalies symptomatic is secondary infection [4], which can mimic other common causes of acute abdomen, such as appendicitis, Meckel’s diverticulitis, or mesenteric cysts [5]. This non-specific presentation, characterized by suprapubic pain, fever, and a palpable infra-umbilical mass, can lead to significant diagnostic delays [6]. While chronic inflammation may result in adhesion to adjacent structures, progression to a severe inflammatory phlegmon causing bowel ischemia and necessitating intestinal resection is an exceptionally rare and poorly documented complication in the pediatric population.Herein, we report the case of a 14-year-old male with a long-standing infected urachal cyst that precipitated segmental small bowel ischemia requiring en-bloc resection and primary anastomosis. This report aims to highlight this severe and unusual complication, underscoring the potential for significant morbidity and the critical importance of timely diagnosis and definitive surgical management for symptomatic urachal anomalies.