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