&NA;Spontaneous umbilical fistula in Crohn's disease is extremely rare, with very few reports found on a 15‐year review of the medical literature. Among those reports, no patient had prior abdominal surgery. Attention was recently focused on this unique entity when spontaneous umbilical fistula was diagnosed in a 64‐year‐old anemic male mechanic with known ileocolic Crohn's disease. This fistula locus occurred despite a right lower quadrant appendectomy incision done 15 years earlier. Spontaneous umbilical fistula pathophysiology and pathways are reviewed.