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Tanaka A, Fujii T, Katami H, Ishikawa R, Haba R, Shimono R. Omphalomesenteric Ducts and Urachal Remnants: A Retrospective Study and Case Series. Cureus 2024; 16:e63877. [PMID: 39099973 PMCID: PMC11298018 DOI: 10.7759/cureus.63877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
PURPOSE The management strategies for umbilical disorders remain undefined. This study aims to review our experience and propose a management algorithm for symptomatic urachal and omphalomesenteric duct anomalies. METHODS We retrospectively reviewed medical charts between January 2013 and September 2017 of 28 patients with clinical concern for umbilical disorders, out of which 10 were diagnosed with omphalomesenteric duct remnants (OMDR) or urachal remnants (UR). We assessed patients' sex, age at operation, initial presentation, imaging findings, surgical approach, histopathological findings, and prognostic outcome. RESULTS Among 10 patients with OMDR or UR, initial presentations were omphalitis in four, umbilical discharge in three, abdominal pain in two, and umbilical mass in one. Ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and voiding cystourethrography were performed in 10, seven, three, and four patients, respectively. Transumbilical extraperitoneal excision from a small expanded umbilical incision and laparoscopic approach combined with transumbilical excision was performed in eight and two patients, respectively. Postoperative wound infection occurred in 10% of patients. DISCUSSION AND CONCLUSION Ultrasonography was mostly used as an initial diagnostic modality, and in cases in which there were signs of infection, they were drained adequately; CT/MRI was chosen for further evaluation of suspicious cases for other complications. Thus, we recommended surgical excision in cases with persistent umbilical disorders. The umbilical approach displays good cosmetic results with easy, complete excision, and the laparoscopic approach could be an excellent diagnostic and therapeutic method for the management of complicated conditions.
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Affiliation(s)
- Aya Tanaka
- Pediatric Surgery, Kagawa University, Takamatsu, JPN
| | | | - Hiroto Katami
- Pediatric Surgery, Kagawa University, Takamatsu, JPN
| | - Ryou Ishikawa
- Diagnostic Pathology, Kagawa University Hospital, Takamatsu, JPN
| | - Reiji Haba
- Diagnostic Pathology, Kagawa University Hospital, Takamatsu, JPN
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Mao K, Wang L, Mao Y, Shang X, Zhou G, Zhao P. Case Report: Intravesical and extravesical urachal cyst in children with lower abdominal pain and hematuria. Front Pediatr 2024; 12:1410976. [PMID: 38887563 PMCID: PMC11180779 DOI: 10.3389/fped.2024.1410976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/17/2024] [Indexed: 06/20/2024] Open
Abstract
Bladder urachal cysts in children are a rare form of urachal abnormality. In this paper, we present a case of atypical imaging that presented with lower abdominal pain accompanied by hematuria, resulting in the formation of both internal and external urachal cysts in a child. A 6-year-old male child presented with repeated abdominal pain over a span of 4 days. Color ultrasound and pelvic CT scans revealed a soft tissue lesion on the right anterior wall of the bladder with an unclear boundary from the bladder wall. Voiding Cystourethrography (VCUG) showed no significant abnormalities in the bladder, while routine urine testing was positive for hematuria. A cystoscopy was simultaneously performed with a laparoscopic resection of the urachal cyst. Intraoperative cystoscopy identified the intravesical lesion, which was precisely removed using a cystoscope-assisted laparoscopy. Postoperative pathology confirmed that both extravesical and intravesical lesions were consistent with a urachal cyst. No complications were observed after the operation, and no recurrence was noted during a six-month follow-up. Therefore, for urachal cysts at the bladder's end, the possibility of intravesical urachal cysts should not be excluded, especially in patients with microscopic hematuria. We recommend performing cystoscopy simultaneously with laparoscopic urachal cyst removal to avoid missing intravesical lesions.
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Affiliation(s)
- Kaiyi Mao
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Leibo Wang
- Urology Surgery, Beijing Jishuitan Hospital Guizhou Hospital, Guiyang, China
| | - Yuchen Mao
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Xianhui Shang
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Guangxu Zhou
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Peng Zhao
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
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Bertoni M, Pintucci A, Locatelli A, Miranda A. Diffuse peritonitis secondary to urachal cyst abscess in a postpartum patient. Int J Surg Case Rep 2024; 118:109584. [PMID: 38579600 PMCID: PMC11004866 DOI: 10.1016/j.ijscr.2024.109584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Urachal cyst infections during pregnancy are exceptionally rare, posing diagnostic challenges. This case report contributes to the limited literature, emphasizing the rarity, diagnostic difficulties, and the need for heightened healthcare provider awareness for timely intervention. PRESENTATION OF CASE A 32-year-old pregnant woman with persistent pelvic pain, fever, and urinary symptoms sought care with inconclusive initial diagnoses despite multiple ER visits. Labor revealed a palpable mass, and postpartum, a CT scan identified a urachal cyst abscess. Urgent laparoscopy confirmed peritonitis, leading to cyst removal, antibiotics, and a subsequent laparotomy. Histology confirmed an abscessed urachal cyst. DISCUSSION Urachal cyst infections in pregnancy, exceptionally rare and diagnostically challenging, highlight the importance of considering them in abdominal pain differentials. Diagnostic tools, such as ultrasound and CT scans, can be misleading, emphasizing the necessity for a multidisciplinary approach. CONCLUSION This case report underscores the challenges in diagnosing and managing an infected urachal cyst during pregnancy, stressing the need for awareness and a comprehensive diagnostic approach for optimal outcomes. The rarity of such cases warrants increased attention within the medical community.
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Affiliation(s)
- Martina Bertoni
- School of Medicine and Surgery, University of Milano Bicocca, Italy.
| | - Armando Pintucci
- Obstetrics and Gynecology, Pio XI Hospital, Desio, ASST Brianza, Italy.
| | - Anna Locatelli
- Obstetrics Unit, IRCCS Fondazione San Gerardo dei Tintori, Monza, Italy.
| | - Angelo Miranda
- General Surgery, Pio XI Hospital, Desio, ASST Brianza, Italy.
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Gelikman DG, Ibanez KR, Ghattas YS, Craver EC, Casas-Melley AT, Ellsworth P, Seth A. Management of urachal anomalies in pediatric patients: A comparison of treatment strategies between pediatric urology and general surgery. J Pediatr Urol 2024; 20:75.e1-75.e8. [PMID: 37802719 DOI: 10.1016/j.jpurol.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Persistence of embryonic urachal structures due to a failure of the urachus to involute into the median umbilical ligament is known as a urachal anomaly (UA). UAs may remain asymptomatic or lead to abdominal pain and recurrent infections. Management of UAs in pediatric patients has historically lacked a clear consensus between conservative and surgical management. While both urologists and general surgeons manage this pathology, a comparison of management style and outcomes between these specialties has not been published to our knowledge. OBJECTIVE To (1) evaluate trends in management of UAs among pediatric urologists and general surgeons across three tertiary care children's hospitals and (2) identify factors that place patients at higher risk for requiring surgery. STUDY DESIGN All patients diagnosed with a UA from 2016 to 2020 at our multi-site institution were identified by ICD-10 code Q64.4 "malformation of the urachus" and retrospectively reviewed. Patient demographics, treatment specialty, remnant subtype, and management strategy were recorded. Data was dichotomized between both urology and general surgery as well as between surgical and nonsurgical intervention to identify and compare management strategies. RESULTS Overall, 143 patients diagnosed with UAs were identified. Of these patients, 74 were treated by urology and 69 were treated by general surgery. Patients who were treated by urology were significantly more likely to receive conservative treatment (66.2% treated conservatively vs. 33.8% treated surgically), while patients treated by general surgery were significantly more likely to undergo surgery (84.1% treated surgically vs. 15.9% treated conservatively, p < .0001). Though, urology was more likely to treat patients who presented incidentally (p < .01), and general surgery was more likely to treat patients who presented with an infected remnant (p < .01). Patients of male sex were more likely overall to receive surgery compared to female patients (p < .01). DISCUSSION Management of UAs by urologists was more conservative than general surgeons. However, both specialties treat distinctly different patient presentations, with urology managing more incidental remnants and general surgery operating on more emergent, infected urachi. Limitations of the study included its retrospective nature and the insufficient reporting of urachal remnant subtypes and presence of infection among patients. CONCLUSIONS Management strategies of UAs differ among urology and general surgery, but surgical and conservative treatments are necessary to appropriately treat their distinct patient populations. This study provides valuable insight into current practices of UA management and may help to inform future treatment.
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Affiliation(s)
- David G Gelikman
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Kristen R Ibanez
- University of Central Florida College of Medicine, Orlando, FL, USA
| | | | - Emily C Craver
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Adela T Casas-Melley
- University of Central Florida College of Medicine, Orlando, FL, USA; Department of Surgery, Division of Pediatric Surgery, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA
| | - Pamela Ellsworth
- University of Central Florida College of Medicine, Orlando, FL, USA; Department of Surgery, Division of Urology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA
| | - Abhishek Seth
- University of Central Florida College of Medicine, Orlando, FL, USA; Department of Surgery, Division of Urology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA.
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Sghaier A, Lamloum E, Debaibi M, Sridi A, Chouchene A. Surgical management of benign noninfected urachal cysts in adult patients: two case reports. J Med Case Rep 2023; 17:214. [PMID: 37221572 DOI: 10.1186/s13256-023-03944-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Abnormalities of the urachus include the patent urachus, cysts, sinus, and fistula. Each of these entities represents a failure of complete obliteration of the urachus. Contrary to other urachus anomalies, urachal cysts are usually small and silent unless they are infected. The diagnosis is often made during childhood. A benign noninfected urachal cyst discovered in adulthood is a rare condition. CASE PRESENTATION Herein we report two cases of benign noninfected urachal cysts in adults. The first case is a 26-year-old Tunisian white man who presented with complaints of clear fluid draining from the base of the umbilicus evolving for a week, with no other associated symptoms. The other case was 27-year-old Tunisian white woman who was referred to the surgery department with a history of intermittent draining of clear fluid from the umbilicus. The two cases had laparoscopic resection of urachus cysts. DISCUSSION Laparoscopy represents a good alternative for the management of persistent or infected urachus, especially when this is suspected, despite a lack of radiological evidence. Laparoscopy in the management of urachal cysts is safe, effective, and offers good cosmesis, with all the advantages of a minimally invasive approach. CONCLUSION Managing persistent and symptomatic urachal anomalies requires a wide surgical excision. Such intervention is recommended to prevent symptom recurrence and complications, most notably malignant degeneration. A laparoscopic approach offers excellent outcomes, and is recommended to treat these abnormalities.
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Affiliation(s)
- Asma Sghaier
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
| | - Eya Lamloum
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mehdi Debaibi
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Azza Sridi
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Adnene Chouchene
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Bawahab MA. Laparoscopic management of symptomatic urachus remnants in adults: A retrospective study. J Minim Access Surg 2023; 19:217-222. [PMID: 37056087 PMCID: PMC10246646 DOI: 10.4103/jmas.jmas_72_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022] Open
Abstract
Aim To report our experience in the laparoscopic management of symptomatic urachal remnants (URs) in adults. Patients and Methods A retrospective study included all patients who underwent laparoscopic excision of URs during the period January 2015-January 2020. The following data were retrieved from the files of the patients: demographic data, clinical presentations, intra-operative findings, the procedure performed, operative details, intraoperative or post-operative complications and follow-up period mentioned in the files for those patients. Results The study included 10 patients (four males and six females) with a mean age of 27.8 ± 11.0 years. URs were discovered preoperatively in all patients except one patient who was diagnosed intraoperatively. URs were associated with other pathologies in four patients (40%) that required two simultaneous surgical procedures. Eight patients (80%) presented with simple umbilical discharge and were diagnosed easily by ultrasonography. All patients were managed successfully with laparoscopic excision and umbilical sparing technique. Excision of the dome of the bladder was done on the selective approach to one patient. No patients showed early post-operative complications. Only one patient had stitch sinus 6 months postoperatively due to a concomitant hernia repair rather than due to the excision of the URs. Conclusions Laparoscopic excision of symptomatic urachus is a feasible procedure even when the excision of the bladder is required. It could be performed successfully with other pathologies. It is associated with a low incidence of complications. Laparoscopy allows good visualisation and complete excision that leads to almost no recurrence rate.
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Affiliation(s)
- Mohammed A. Bawahab
- Department of Surgery, Faculty of Medicine, King Khalid University, Abha, Saudi Arabia
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Nakagawa Y, Sumida W, Amano H, Uchida H, Hinoki A, Shirota C, Makita S, Okamoto M, Ogata S, Takimoto A, Takada S, Kato D, Gohda Y. Preoperative imaging contributes to pathologically complete resection of the urachal remnant by determining an appropriate surgical approach without unnecessary and excessive surgical invasion: a retrospective study. BMC Urol 2022; 22:207. [PMID: 36536334 PMCID: PMC9764728 DOI: 10.1186/s12894-022-01153-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The urachus is an embryonic structure that connects the bladder to the allantois during early embryonic development. Occasionally, it fails to disappear at birth, leading to a case of urachal remnant (UR). This study aimed to determine whether our policy for selecting an appropriate UR resection approach is valid. We performed preoperative imaging to examine whether UR continued toward the bladder apex. If so, the UR and bladder apex were excised using the trans-umbilical approach, in addition to laparoscopy, if necessary. If preoperative imaging indicated that the UR ended near the umbilicus, the UR from the umbilicus to the duct end was resected. Pathological evaluations were performed to determine the appropriateness of the surgical approach indicated by preoperative imaging. METHODS We retrospectively reviewed pediatric patients with UR who underwent surgery between 2015 and 2021. Their background characteristics and surgical outcomes were evaluated. RESULTS Twenty patients with UR were included (median age, 7 [interquartile range, 2-10.25] years). UR continued toward the bladder apex in 10 patients and ended near the umbilicus in 10 patients. Urachus tissue at the bladder site was observed when the UR and bladder apex were excised. When UR was resected from the umbilicus to the duct end, urachus tissue was not pathologically detected at the resection margin. CONCLUSION Our policy results in complete resection without excessive surgical invasion.
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Affiliation(s)
- Yoichi Nakagawa
- grid.27476.300000 0001 0943 978XDepartment of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Wataru Sumida
- grid.27476.300000 0001 0943 978XDepartment of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Hizuru Amano
- grid.27476.300000 0001 0943 978XDepartment of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Hiroo Uchida
- grid.27476.300000 0001 0943 978XDepartment of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Akinari Hinoki
- grid.27476.300000 0001 0943 978XDepartment of Rare/Intractable Cancer Analysis Research, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Chiyoe Shirota
- grid.27476.300000 0001 0943 978XDepartment of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Satoshi Makita
- grid.27476.300000 0001 0943 978XDepartment of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Masamune Okamoto
- grid.27476.300000 0001 0943 978XDepartment of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Seiya Ogata
- grid.27476.300000 0001 0943 978XDepartment of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Aitaro Takimoto
- grid.27476.300000 0001 0943 978XDepartment of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Shunya Takada
- grid.27476.300000 0001 0943 978XDepartment of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Daiki Kato
- grid.27476.300000 0001 0943 978XDepartment of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Yousuke Gohda
- grid.27476.300000 0001 0943 978XDepartment of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
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Ilea C, Ilie OD, Stoian IL, Scripcariu IS, Doroftei B. An Unusual Case of Urachal Cyst Misdiagnosed as a Paraovarian Cyst: Ultrasound Assessment and Differential Diagnosis. Diagnostics (Basel) 2022; 12:diagnostics12123166. [PMID: 36553173 PMCID: PMC9777174 DOI: 10.3390/diagnostics12123166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
The urachus is an embryologic remnant of the cloaca that usually degenerates after birth, resulting from the obliteration of the allantois, whose role is to connect the bladder to the umbilicus. Incomplete removal of the lumen may give rise to different malformations of the median umbilical ligament after birth. Although in the pediatric population urachus are common, most cases are asymptomatic and may go unrecognized until adulthood and give rise to cysts, rarely reported in the literature. Thus, in this manuscript we present the circumstances of a 43-year-old Romanian woman showing hypogastric pain of moderate intensity for three weeks, radiation in the left lower limb, menstrual cycle abnormalities, and dysmenorrhea. Based on the initial examinations, a paraovarian cyst measuring 80 mm was noted. Through the subsequent magnetic resonance imaging (MRI) conducted, a hypoechoic mass was detected, and the patient underwent a tumorectomy and partial cystectomy. A 9.7/7.5-cm tumor was excised, and the anatomopathological result was urachal mucinous cystadenoma. It came to our attention that relatively scarce data were found in the literature, with only seven studies with the diagnosis of the urachal cyst.
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Affiliation(s)
- Ciprian Ilea
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania
| | - Ovidiu-Dumitru Ilie
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University, Carol I Avenue, No. 20A, 700505 Iasi, Romania
- Correspondence: (O.-D.I.); (I.-L.S.)
| | - Irina-Liviana Stoian
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania
- Correspondence: (O.-D.I.); (I.-L.S.)
| | - Ioana-Sadyie Scripcariu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania
| | - Bogdan Doroftei
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
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Acute urachal cystitis in two children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Shi ZY, Hou SL, Li XW. Silver dressing in the management of an infant's urachal anomaly infected with methicillin-resistant Staphylococcus aureus: A case report. World J Clin Cases 2022; 10:2629-2636. [PMID: 35434059 PMCID: PMC8968584 DOI: 10.12998/wjcc.v10.i8.2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/29/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Symptomatic urachal anomalies are rare disorders. The management of urachal remnants has historically been surgical excision because of the connection between urachal remnants and risk of malignancy development later in life. However, recent literature suggests that urachal anomalies that do not extend to the bladder can be treated with conservative management. In this case, we report a newborn with an infected urachal remnant who was treated with a combination of antibiotics and a silver-based dressing and finally recovered well.
CASE SUMMARY Female baby A, weighing 2.88 kg at 38+5 wk of gestational age, was referred to the hospital because of a red, swollen umbilicus approximately 2 cm × 2 cm in size with yellow purulent exudate. Through physical and ultrasound examination, the baby was finally diagnosed with a urachal anomaly. We first used oxacillin to prevent infection for 3 d. On the 4th day, microbiology testing of the umbilical exudate revealed the presence of methicillin-resistant Staphylococcus aureus (MRSA). We changed the treatment with oxacillin to vancomycin for systemic infection and treated the umbilical inflammation with a silver sulfate dressing. After 5 d, the symptoms of the umbilicus disappeared, and we discontinued silver dressing application. On the 12th day, umbilical exudate testing was negative for MRSA. On the 14th day, the baby's blood testing showed a white blood cell count of 14.7 × 109/L, neutrophil percentage of 27.8%, and C-reactive protein level of 1.0 mg/L, suggesting that the infection had been controlled. We stopped treatment, and the baby was discharged with no complications. In this case, the infected urachal anomaly was cured with silver dressing and antibiotic application instead of surgical methods, which was a different course from that of some other urachal remnant cases.
CONCLUSION Anomalies that do not connect with the bladder can be treated with nonoperative management, including application of conservative antibiotics and local intervention with silver-based dressings. Silver sulfate dressings are absolutely safe for neonates with judicious use, and they play an established role in preventing infection without resistance, which is a common problem with other antibiotics and antiseptics.
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Affiliation(s)
- Ze-Yao Shi
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Shu-Lin Hou
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Xiao-Wen Li
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
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Nissen M, Rogge P, Sander V, Alrefai M, Romanova A, Tröbs RB. Pediatric Urachal Anomalies: Monocentric Experience and Mini-Review of Literature. CHILDREN 2022; 9:children9010072. [PMID: 35053696 PMCID: PMC8774176 DOI: 10.3390/children9010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/31/2021] [Accepted: 01/02/2022] [Indexed: 11/16/2022]
Abstract
Background: Surgery is the current mainstay for the treatment of urachal anomalies (UA). Recent literature data support the theory of a spontaneous resolution within the first year of life. The aim of this study, comprising solely surgically treated children, was to identify age specific patterns regarding symptoms and outcomes that may support the non-surgical treatment of UA. Methods: Retrospective review on the clinico-laboratory characteristics of 52 children aged < 17 years undergoing resection of symptomatic UA at our pediatric surgical unit during 2006–2017. Data was dichotomized into age > 1 (n = 17) versus < 1 year (n = 35), and complicated (pre-/post-surgical abscess formation or peritonitis, n = 10) versus non-complicated course (n = 42). Results: Children aged < 1 year comprised majority (67%) of cohort and had lower complication rates (p = 0.062). Complicated course at surgery exclusively occurred in patients aged > 1 year (p = 0.003). Additionally, complicated group was older (p = 0.018), displayed leukocytosis (p < 0.001) and higher frequencies regarding presence of abdominal pain (p = 0.008) and abdominal mass (p = 0.034) on admission. Regression analysis identified present abdominal pain (OR (95% CI), 11.121 (1.152–107.337); p = 0.037) and leukocytosis (1.435 (1.070–1.925); p = 0.016) being associated with complicated course. Conclusions: This study provides evidence that symptomatic disease course follows an age-dependent complication pattern with lower complication rates at age < 1 year. Larger, studies have to clarify, if waiting for spontaneous urachal obliteration during the first year of life comprises a reasonable alternative to surgery.
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Affiliation(s)
- Matthias Nissen
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Group, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (P.R.); (V.S.); (M.A.); (A.R.)
- Correspondence: or ; Tel.: +49-23021733709; Fax: +49-23021731699
| | - Phillip Rogge
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Group, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (P.R.); (V.S.); (M.A.); (A.R.)
| | - Volker Sander
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Group, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (P.R.); (V.S.); (M.A.); (A.R.)
| | - Mohamad Alrefai
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Group, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (P.R.); (V.S.); (M.A.); (A.R.)
| | - Anna Romanova
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Group, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (P.R.); (V.S.); (M.A.); (A.R.)
| | - Ralf-Bodo Tröbs
- Department of Pediatric Surgery, St. Johannes Hospital, Helios Group, An der Abtei 7-11, D-47166 Duisburg, Germany;
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García García L, Ballesta B, Rodríguez Talavera J, Morales Orribo N, Carrión A. Urachal Pathology: Review of Cases. Urol Int 2021; 106:195-198. [PMID: 33957634 DOI: 10.1159/000515648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/11/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The urachus is an embryologic remnant which is formed from the obliteration of the allantois. Urachal abnormalities are caused when defective obliteration of the urachus happens. They are an infrequent condition. Incidence is estimated to be between 5,000 and 8,000 live births. Its diagnosis and management remain a challenge due to the lack of an specific clinical picture and the controversy about the management. OBJECTIVE The objective of this study is to assess the clinical presentation, diagnosis, therapeutic management, and outcomes of urachal anomalies in our health area. MATERIALS AND METHODS We performed a retrospective review of all cases of urachal anomalies recorded Tenerife (southern health area), La Gomera, and El Hierro Islands during a 5 year period. RESULTS Twenty-three cases of urachal pathology were included. The mean age of presentation was 32 years old. 73.9% were male. 65% were diagnosed in adults. In 30.3% of the cases, it was a casual finding. Symptoms included fever, umbilical exudate, hematuria, abdominal pain, and umbilical granuloma. The main diagnostic tests were ultrasound and computed tomography scan. Treatments were selected conservative management (43.5%), selective resection, partial cystectomy, and radical cystectomy. All patients had a good evolution. However, 2 cases where benign tumors were suspected, clinically, had a final histology of cancer in the specimen. CONCLUSIONS Due to the lack of a specific clinical picture and undefined findings in image tools, diagnosis is difficult and it may be inaccurate. Despite more data are needed, our results suggest that the systematic excision of urachal lesions could result in safer outcomes since cases where a benign lesion is clinically suspected might result in malignant tumors.
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Affiliation(s)
- Lorena García García
- Department of Urology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Begoña Ballesta
- Department of Urology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Nuria Morales Orribo
- Department of Urology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Almudena Carrión
- Department of Urology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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Zmora O, Sekler O, Rimon A, Schwartz-Neiderman A, Beloosesky R. A Very Large Patent Urachus Manifesting as an Umbilical Cord "Cyst" and Obliterating Postnatally. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:853-854. [PMID: 32845039 DOI: 10.1002/jum.15449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Osnat Zmora
- Department of Pediatric Surgery, Shamir Medical Center, Zerifin, Be'er Ya'akov, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Opal Sekler
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Rimon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Emergency Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Taher H, Ramnarine S, Smeulders N, Desai D, Mushtaq I, Cuckow P, Cherian A. Patent urachus and bladder outflow obstruction—chance or consequence? A study of a cohort of patients with complete patent urachus presenting to a tertiary urological center and a review of literature. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-020-00069-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To explore the association between patent urachus and bladder outflow obstruction (BOO). A retrospective review of patient records over a 35-year period (1983–2018) with complete patent urachus was performed. Antenatal ultrasound findings were noted, and postnatal investigations included ultrasound (US), micturating cystourethrogram (MCUG), functional nuclear medicine scans (MAG3, DTPA, and DMSA), and serum creatinine. Associated anomalies and management in all patients were analyzed.
Results
Sixty-six patients with all types of urachal remnants were identified of whom only 16 had a patent urachus. All presented clinically with a discharging umbilicus, 10/16 confirmed on MCUG and 4 had umbilical cord cysts on antenatal US. Twenty-five percent had associated bladder outlet obstruction (BOO): etiologies included atresia of posterior urethra, congenital urethral hypoplasia, urethral atresia with prune belly syndrome, and sacrococcygeal teratoma. Vesicoureteral reflux (VUR) was confirmed in 37%, and four of them had bladder outlet obstruction (BOO).
Conclusion
With patent urachus, bladder outflow obstruction occurs in the minority. Based on our findings, we commend US and cystogram to document VUR. The isolated PU should be treated nonoperatively up to a year of age. Renal function should be checked with the finding of VUR. The etiopathogenesis of the condition remains uncertain.
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Orbatu D, Alaygut D. Evaluation and management of urachal remnants in children. Pediatr Int 2020; 62:1158-1161. [PMID: 32347613 DOI: 10.1111/ped.14272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND This study aimed to evaluate the diagnosis and treatment of pediatric patients with urachal remnants. METHODS Medical records of patients diagnosed with urachal remnants between 2015-2019 were evaluated retrospectively. Age, gender, admission complaints, diagnosis, size of cysts, the complications that developed, and treatment modalities were recorded. RESULTS The study population consisted of 15 cases including seven girls. Most of the cases were asymptomatic. The urachal remnants were detected by ultrasonography. The most common symptom in symptomatic patients was abdominal pain and umbilical discharge. Three patients required surgery and most of them were conservatively followed up. Complication, infection, and bladder rupture were observed in one case. CONCLUSIONS Follow-up of patients with urachal remnants can be performed conservatively. The type of complaint and the presence of clinical and radiological regression (if any) are important for deciding the treatment during the follow-up. However, conservative follow-up is more prominent today, as shown in this study.
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Affiliation(s)
- Dilek Orbatu
- Department of Pediatrics, Izmir University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Demet Alaygut
- Department of Pediatric Nephrology, Izmir University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
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Operative management of urachal remnants: An NSQIP based study of postoperative complications. J Pediatr Surg 2020; 55:873-877. [PMID: 32145974 DOI: 10.1016/j.jpedsurg.2020.01.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/25/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE The identification of urachal remnants is occurring more in infancy. Despite evidence that nonoperative management is effective, operative management remains common and has a high complication rate. We sought to determine if the complication rate after urachal resection is associated with age. METHODS Patients undergoing urachal remnant resection were identified from ACS NSQIP Pediatric from 2013 to 2017. Exclusion criteria included emergent operations, contaminated wounds, and any additional procedures. Patients were compared based on complication rates, need for reoperation or readmission, and length of stay. RESULTS A complication occurred in 16 of 476 patients (3.3%), 6 (1.3%) had reoperation, and 11 (2.3%) were readmitted. The median age for patients requiring reoperation was lower (0.1 years) than those not (1.3 years; p = 0.004). The median age of those readmitted was lower (0.4 years) than those not (1.4 years, p = 0.03), and a weak trend of longer length of stay in younger patients was identified (ρ = -0.16, p < 0.001). CONCLUSIONS Operative management of younger patients resulted in greater risk of reoperation, readmission, and longer length of stay. Given that nonoperative management is effective, it may be of benefit to delay resection of urachal remnants to after 1 year of age. STUDY TYPE Treatment study. LEVEL OF EVIDENCE Level III.
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Abstract
INTRODUCTION Urachal cyst is an exceptionally rare disease in children caused by the incomplete obliteration of the urachal remnant. Urachal cysts seldom cause symptoms unless a secondary infection occurs. The symptoms of an infected urachal cyst are nonspecific and may be similar to acute appendicitis or other acute abdominal conditions. However, complications attributable to a delayed diagnosis can endanger the life of a patient. PATIENT CONCERNS A 5-year-old boy presented with a 3-day history of severe intermittent lower abdominal pain. DIAGNOSIS Infected urachal cyst. INTERVENTIONS The patient was treated with surgical resection of the urachus, followed by intravenous antibiotics during the hospitalization. OUTCOMES The patient was discharged without incident 7 days after the operation. With his follow-up in our out-patient department, he recovered well without any sequelae in the 6 months post-surgery. CONCLUSION We suggested using the abdominal echo scan to differentiate the urachal cyst because of its high sensitivity and nonradioactive characteristic, and computed tomography is a typical diagnostic tool for urachal cysts. The mainstream management of an infected urachal cyst remains surgical excision. Complete excision of urachal cysts is relatively easy in a pediatric patient and the risk of subsequent infection is low; however, patients tend to have a low, although possible, risk of potential malignant transformation over their lifetimes.
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Affiliation(s)
- I-Shan Tsai
- Department of Pediatrics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City
| | - Lung-Huang Lin
- Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
| | - Shih-Pin Hung
- Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
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Abstract
Urachal anomalies are classified into four types depending on the level of persistence of the embryonic urachal remnants between the urinary bladder and the umbilicus: patent urachus, umbilical-urachal sinus, urachal cyst, and vesico-urachal diverticulum. Due to the increasing use of cross-sectional imaging, urachal anomalies are frequently detected as incidental findings. Imaging plays a pivotal role in the initial diagnosis, evaluation of complications, treatment follow-up, and long-term surveillance of patients with urachal anomalies. Different urachal anomalies demonstrate characteristic imaging features that aid in a timely diagnosis and guide treatment. A patent urachus is visualized as an elongated tubular structure between the umbilicus and the urinary bladder. While umbilical-urachal sinus appears as focal dilatation at the umbilical end of the urachal remnant, the vesico-urachal diverticulum presents as a focal outpouching of the urinary bladder at anterosuperior aspect. Urachal cysts are identified as midline fluid-filled sacs most frequently located near the dome of the urinary bladder. Untreated urachal anomalies could progress into potential complications, including infection and malignancy. Knowledge regarding imaging features of urachal anomalies helps in timely diagnosis, treatment, follow-up, and early detection of complications.
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Dethlefs CR, Abdessalam SF, Raynor SC, Perry DA, Allbery SM, Lyden ER, Azarow KS, Cusick RA. Conservative management of urachal anomalies. J Pediatr Surg 2019; 54:1054-1058. [PMID: 30867097 DOI: 10.1016/j.jpedsurg.2019.01.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 01/27/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study was to evaluate trends in management of urachal anomalies at our institution and the safety of nonoperative care. METHODS Based on our experience managing urachal remnants from 2000 to 2010 (reported in 2012), we adopted a more conservative approach, including preoperative antibiotic use, refraining from using voiding cystourethrograms (VCUG), postponing surgery until at least six months of age, and considering nonoperative management. A retrospective analysis of urachal anomaly cases was conducted (2011-2016) to assess trends in practice. Charts indicating anomalies of the urachus were pulled and trends in management (nonoperative versus surgical treatment), VCUG and antibiotic use, and outcomes were reviewed. RESULTS Data from 2000-2010 and 2013-2016 were compared. Our findings indicate care has shifted towards nonoperative management. A smaller proportion of patients from 2013-2016 was treated surgically compared to 2000-2010. Patients receiving nonoperative treatment exhibited lower rates of complication relative to surgically managed cases. VCUGs were eliminated as a diagnostic tool for evaluating urachal anomalies. Prophylactic preoperative antibiotic use was standardized. No patients with a known urachal remnant presented later with an abscess or sepsis. CONCLUSIONS We find that a shift towards nonoperative treatment of urachal anomalies did not adversely affect overall outcomes. We recommend observing minimally symptomatic patients, especially those under six months old. STUDY TYPE Performance improvement. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Christopher R Dethlefs
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE; Department of Surgery, University of Nebraska College of Medicine, Omaha, NE
| | - Shahab F Abdessalam
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE; Department of Surgery, University of Nebraska College of Medicine, Omaha, NE
| | - Stephen C Raynor
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE; Department of Surgery, University of Nebraska College of Medicine, Omaha, NE
| | - Deborah A Perry
- Department of Pathology, Children's Hospital & Medical Center, Omaha, NE
| | - Sandra M Allbery
- Department of Radiology, Children's Hospital & Medical Center, Omaha, NE
| | - Elizabeth R Lyden
- Department of Biostatistics, University of Nebraska College of Public Health. Omaha, NE
| | - Kenneth S Azarow
- Department of Surgery, Oregon Health and Science University, Portland, OR
| | - Robert A Cusick
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE; Department of Surgery, University of Nebraska College of Medicine, Omaha, NE.
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Elkbuli A, Kinslow K, Ehrhardt JD, Hai S, McKenney M, Boneva D. Surgical management for an infected urachal cyst in an adult: Case report and literature review. Int J Surg Case Rep 2019; 57:130-133. [PMID: 30959359 PMCID: PMC6453943 DOI: 10.1016/j.ijscr.2019.03.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/04/2019] [Accepted: 03/24/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Incomplete urachal obliteration during fetal development gives rise to distinct malformations of the median umbilical ligament. Most anomalies are asymptomatic and resolve during early infancy, but some go unrecognized until adulthood. These rare cases can present with acute abdominal symptomatology secondary to infected urachal remnants. PRESENTATION OF CASE A 20-year-old man presented with periumbilical pain. Physical exam showed a warm, erythematous infra-umbilical mass that was tender to palpation. CT revealed an infected urachal cyst. The patient underwent urachal abscess incision and drainage with cyst excision. The patient returned home on postoperative day two. Two-week outpatient follow-up confirmed an uncomplicated recovery. DISCUSSION Surgical excision of urachal anomalies in adults is curative and preventive against recurrent infection and malignancy, but preoperative management is currently unstandardized. Current literature recommends a two-stage approach characterized by preoperative antibiotics and cyst incision and drainage followed later by complete surgical excision. Our patient underwent a single therapeutic approach with preoperative antibiotics and definitive operative excision. Our patient had a comparable outcome with no complications and a short hospitalization. CONCLUSION Preoperative antibiotics with excision of urachal remnants was effective in our case. Staged approaches are appropriate in complicated cases as a means to reduce post-operative infection rates and hospital stays. Urachal remnant excision is recommended in adults to prevent future malignancy.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States.
| | - Kyle Kinslow
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States
| | - John D Ehrhardt
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States
| | - Shaikh Hai
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
| | - Dessy Boneva
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
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Liu Z, Yu X, Hu J, Li F, Wang S. Umbilicus-sparing laparoscopic versus open approach for treating symptomatic urachal remnants in adults. Medicine (Baltimore) 2018; 97:e11043. [PMID: 29952943 PMCID: PMC6039640 DOI: 10.1097/md.0000000000011043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The traditional surgical approach for removing a symptomatic urachal remnant is via a lower midline laparotomy and infraumbilical incision or a laparoscopic approach with umbilicoplasty. We reviewed our experience with umbilicus-sparing laparoscopic urachal remnant excision in a single-center study and evaluated its efficacy versus open approach (OA). This study was a retrospective study. Between March 2012 and September 2016, 32 consecutive patients with symptomatic urachal remnants underwent the umbilicus-sparing laparoscopic approach (USLA) (n = 17) or OA (n = 15). The efficacy, recovery, and long-term outcomes were reviewed. Our Results showed that the clinical characteristics of the patients in each group, such as age, gender, body mass index (BMI), and disease type, had no significant differences (P > .05). No significant difference was found in the surgical procedure times (76.1 ± 15.4 vs 69.2 ± 13.9 minutes, P = .189) and intraoperative blood loss (29.4 ± 13.3 vs 32.2 ± 12.9 mL, P = .543) between the USLA groups and OA groups. However, the mean postoperative hospital stay (patients with bladder cuff excision: 4.1 ± 1.8 vs 6.1 ± 1.4 days, P = .040 and patients without bladder cuff excision: 1.8 ± 0.5 vs 3.6 ± 0.8 days, P < .001) and the time of full recovery (11.2 ± 1.9 vs 15.6 ± 3.1 days, P < .001), the USLA group were both significantly shorter than that of the OA group. No infected recurrence and malignant transformation had occurred at a mean follow-up of 32.4 ± 8.1 and 34.1 ± 8.8 months in USLA group and OA group, respectively. In conclusion, to minimize the morbidity of radical excision, umbilicus-sparing management of benign urachal remnants in adults is a safe and efficacious alternative with superior cosmetic outcomes, postoperative recovery compared with an OA or umbilicoplasty.
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Ahmed H, Howe AS, Dyer LL, Fine RG, Gitlin JS, Schlussel RN, Zelkovic PF, Palmer LS. Robot-assisted Laparoscopic Urachal Excision in Children. Urology 2017; 106:103-106. [DOI: 10.1016/j.urology.2017.03.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/15/2017] [Accepted: 03/21/2017] [Indexed: 12/26/2022]
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The role of laparoscopy in the management of urachal anomalies in children. ANNALS OF PEDIATRIC SURGERY 2017. [DOI: 10.1097/01.xps.0000513181.72166.fa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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[THE OPTIMAL TROCAR PLACEMENT FOR LAPAROSCOPIC EXCISION OF URACHAL REMNANTS]. Nihon Hinyokika Gakkai Zasshi 2017; 108:182-187. [PMID: 30333439 DOI: 10.5980/jpnjurol.108.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
(Objective) Although laparoscopic excision of urachal remnants has been applied widely, the standard surgical method has yet to be established. The aim of this study, therefore, was to evaluate perioperative outcome and surgical techniques, including the trocar placement at our institution. (Subjects and methods) A total of 20 patients with urachal remnant were treated using laparoscopic surgery between October 2002 and August 2016. 3 trocars were inserted in the peritoneal cavity. Camera trocar was placed at right side of umbilicus and two working trocars were placed at the upper side of umbilicus and right lower quandrant. A 5 mm, 30° angled lens camera was used during operation. (Results) The mean age was 27 years old. There were 16 males and 4 females. The classifications of urachal remnants were urachal sinus (n=18) and urachal diverticulum (n=2). Umbilical excision was performed in 18 case and partial cystectomy were required in 4 cases. 4 trocars were inserted in only one case due to severe adhesion in the peritoneal cavity. Laparoscopic excision was successfully completed in all cases. The mean operative time was 220 minutes and the mean blood loss was minimal. The complications occurred in 5 cases including small intestinal injury (n=2), peritonitis (n=1), wound infection (n=1), intestinal obstruction (n=1) and acute renal failure (n=1) (intestinal obstruction and acute renal failure were occurred in the same case). (Conclusion) Although there are problems such as shortening the operative time and reducing complications, our unique port placement enables good surgical view and easy suturing during partial cystectomy.
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Abstract
BACKGROUND The urachus and the urachal remnants represent a failure in the obliteration of the allantois at birth that connects the bladder to the umbilicus. After birth it obliterates and presents as the midline umbilical ligament. Urachal cyst are the most common urachal anomaly in the pediatric population. The traditional surgical approach is a semicircular infraumbilical incision or a lower midline laparotomy. METHODS In a 10 years period at Pediatric Surgery Department of Vicenza 16 children were diagnosed with urachal anomalies presenting as abdominal or urinary symptoms. Eight underwent open excision; eight were treated by laparoscopic surgery. The average age was 5.5 years (range, 4 months-13 years) in open group and 10 years (range, 1 month-18 years) in laparoscopic group. RESULTS Mean operative time was 63 minutes (range, 35-105 minutes) in open group, 50 minutes (range, 35-90 minutes) in laparoscopic group. There were no postoperative complications. The patients of laparoscopic group were all discharged after few days (range, 2-4 days). Pathological examination confirmed a benign urachal remnant in all cases. Reporting our experience since comparing the two surgical approaches we want to describe the technique step by step of laparoscopic urachal cyst excision as minimally invasive diagnostic and surgical techniques. CONCLUSIONS Laparoscopy represents a useful alternative for the management of persistent or infected urachus, in particular when there's the suspect despite the lack of radiological evidence. The morbidity associated with this approach is very low as the risk or recurrence. Laparoscopy in the management of urachal cyst is safe effective and ensures good cosmesis with all the advantages of minimally invasive approach.
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Affiliation(s)
- Salvatore Fabio Chiarenza
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Cosimo Bleve
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
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de Queiroz Garcia M, de Queiroz Garcia M, Barral CM. Patent Urachus Presenting as Acute Abdomen. J Med Ultrasound 2015. [DOI: 10.1016/j.jmu.2015.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Cheikhelard A, Irtan S, Orbach D, Minard-Colin V, Rod J, Martelli H, Sarnacki S. Urachal rhabdomyosarcoma in childhood: a rare entity with a poor outcome. J Pediatr Surg 2015; 50:1329-33. [PMID: 25913896 DOI: 10.1016/j.jpedsurg.2014.12.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/26/2014] [Accepted: 12/25/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE Rhabdomyosarcoma (RMS) of the urachus is rare and gathered in the "abdominal and other locations" group for oncological treatment purpose, and therefore not well characterized. Our aim was to assess the clinical and prognostic specific features of urachal primary RMS in childhood. METHODS We retrospectively reviewed the charts of 8 patients with an urachal RMS treated between 1984 and 2013 in two Pediatric Oncology Departments. Median follow-up was 42 months (18-100). RESULTS Urachal RMSs were embryonal in 6, alveolar in 1, and not otherwise specified in 1. Age at diagnosis was 4.4 years (2.6-6). All patients had advanced locoregional extension (IRS IIIIV) and 1 had distant metastasis. All had chemotherapy and surgical resection. Six had external radiotherapy. Four had extensive peritoneal recurrence including 2 with distant metastasis, within a median of 25 months (11-82) after the end of treatment. One had metastatic progression under primary treatment. Four of them died between 18 and 57 months after diagnosis, and 1 is still under treatment for a late recurrence. Only 3 are free of disease after 3.3 to 7.9 years of follow-up. CONCLUSIONS Pediatric urachal cancer is rare and poorly identified. In our series, RMS was exclusive in this location. Locoregional extension was always advanced. Prognosis was poor despite current multimodal therapy. We underline the need for new therapeutical strategies.
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Affiliation(s)
- Alaa Cheikhelard
- Pediatric Surgery and Urology Department, AP-HP, Hopital Necker, Paris, France.
| | - Sabine Irtan
- Pediatric Surgery and Urology Department, AP-HP, Hopital Necker, Paris, France
| | - Daniel Orbach
- Pediatric and Adolescent Oncology Department, Institut Curie, Paris, France
| | - Véronique Minard-Colin
- Pediatric and Adolescent Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Julien Rod
- Pediatric Surgery Department, CHU de Caen and Universite de Caen Basse-Normandie, Medical School, Caen, France
| | - Hélène Martelli
- Pediatric Surgery Department, AP-HP, Hopital Bicetre, Le Kremlin-Bicetre, France; HUPS, Universite Paris-Sud, Le Kremlin-Bicetre, France
| | - Sabine Sarnacki
- Pediatric Surgery and Urology Department, AP-HP, Hopital Necker, Paris, France; Universite Paris Descartes, Sorbonne Paris Cite, Paris, France
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Stopak JK, Azarow KS, Abdessalam SF, Raynor SC, Perry DA, Cusick RA. Trends in surgical management of urachal anomalies. J Pediatr Surg 2015; 50:1334-7. [PMID: 26227313 DOI: 10.1016/j.jpedsurg.2015.04.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 04/26/2015] [Accepted: 04/30/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE We have noted an increasing frequency of diagnosed urachal anomalies. The purpose of this study is to evaluate this increase, as well as the outcomes of management at our institution over 10 years. METHODS A retrospective analysis of urachal anomalies at our institution was performed. Inclusion criteria were Anomalies of Urachus (ICD 753.7) or Urinary Anomaly NOS (ICD 753.9) between January 2000 and December 2010. Exclusion criteria were having an asymptomatic urachal remnant incidentally excised. RESULTS Eighty-five patients (49 male, 36 female) presented between 0 and 17 years of age (mean 1.5 years). Diagnoses increased from 0 in 2000 to 21 in 2010. Zero was surgically managed in 2000 while 21 were managed in 2010 (p=0.0145). Fifteen patients (17.6%) were observed with 13 (13/15, or 15.3%) resolving without complication while 2 were operated on. Average time to resolution (clinical or radiologic) was 4.9 months (Range: 0.4-12.6). A total of seventy-two patients (84.7%) underwent excision. Thirty-nine (54%) surgical cases were outpatient while 33 (46%) were admitted. Thirteen (18%) had post-operative complications. Ten (77%) of the complications were wound infections. Patients under 6 months of age accounted for 60% (6 of 10) of all wound infections and 52% (17 of 33) of hospitalizations. CONCLUSIONS Our experience and review of the literature suggest a high complication rate with surgical management in young patients, mostly from infections and support non-operative management of all non-infected urachal remnants in children.
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Affiliation(s)
- Joshua K Stopak
- Department of Anesthesiology, University of Vermont Medical Center, Burlington, VT, 05401, USA.
| | - Kenneth S Azarow
- Department of Surgery, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Shahab F Abdessalam
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE, 68114-4113, USA
| | - Stephen C Raynor
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE, 68114-4113, USA
| | - Deborah A Perry
- Department of Pathology, Children's Hospital & Medical Center, Omaha, NE, 68114, USA
| | - Robert A Cusick
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE, 68114-4113, USA
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Sato H, Furuta S, Tsuji S, Kawase H, Kitagawa H. The current strategy for urachal remnants. Pediatr Surg Int 2015; 31:581-7. [PMID: 25896294 DOI: 10.1007/s00383-015-3712-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Optimal therapy for urachal remnant (UR) in children is controversial. Nonoperative management for symptomatic UR is an alternative. Many papers support the laparoscopic approach but the indication for this is unclear. We review our experience to determine the optimal management of UR. MATERIALS AND METHODS A retrospective chart review of patients from 1990 to 2013 with UR was performed. Patients were analyzed according to age, gender, initial symptoms, type of UR, treatment, and outcome. RESULTS We identified 27 patients (M:F = 17:10). A urachal sinus was found in 16 cases (59%), a urachal cyst in 5 (18%) and a urachal duct in 6 (22%). Eleven (A) were under 1 year, with 16 over 1 year (B). In Group A, the commonest symptom was umbilical granulation (n = 6, 54%). Group B was dominated by abdominal pain (n = 12, 75%). Six cases in Group A needed operation for repeated infections. In 5 cases, the UR disappeared. In Group B, 2 cases were followed conservatively. The others required surgery. From 2009, we utilized a laparoscopic approach (LA, n = 7) rather than the classical umbilical approach (UA, n = 13). The operation time was not significantly different (LA = 124 min: UA = 110 min, P > 0.05). There was a tendency for shorter hospital stay following LA (LA = 7.5 days: UA = 10.9 days). Complete resection was always possible using UA in Group A but a more caudal incision (mean 3.6 cm) was required in group B. LA enabled confirmation of the complete resection with three 5 mm ports in Group B. There were no operative complications after LA against two wound infections, one of which suffered a disruption, after UA. CONCLUSION Conservative follow-up is recommended for UR under 1-year old except when there are repeated infections. The umbilical approach is enough for infants. Laparoscopic surgery is recommended in older children.
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Affiliation(s)
- Hideaki Sato
- Department of Pediatric Surgery, St. Marianna University Yokohama City Seibu Hospital, 1197-1, Yasashi-cho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan,
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Siow SL, Mahendran HA, Hardin M. Laparoscopic management of symptomatic urachal remnants in adulthood. Asian J Surg 2015; 38:85-90. [DOI: 10.1016/j.asjsur.2014.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 02/18/2014] [Accepted: 04/24/2014] [Indexed: 12/26/2022] Open
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Abstract
Patent urachus is one of the least commonly seen of the urachal anomalies. In this report, we present a case of a patent urachus in a15-day-old female who presented with leakage from the umbilical site. The purpose of this article is to discuss the embryology, clinical manifestations, diagnosis, and management of patent urachus.
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A Comprehensive Review of Pediatric Urachal Anomalies and Predictive Analysis for Adult Urachal Adenocarcinoma. J Urol 2015; 193:632-6. [DOI: 10.1016/j.juro.2014.09.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2014] [Indexed: 11/19/2022]
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Bertozzi M, Riccioni S, Appignani A. Laparoscopic Treatment of Symptomatic Urachal Remnants in Children. J Endourol 2014; 28:1091-6. [DOI: 10.1089/end.2014.0203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mirko Bertozzi
- S.C. di Clinica Chirurgica Pediatrica, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Sara Riccioni
- Sezione di Radiologia, Dipartimento di Scienze Chirurgiche, Radiologiche ed Odontostomatologiche, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Antonino Appignani
- S.C. di Clinica Chirurgica Pediatrica, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
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Nogueras-Ocaña M, Rodríguez-Belmonte R, Uberos-Fernández J, Jiménez-Pacheco A, Merino-Salas S, Zuluaga-Gómez A. Urachal anomalies in children: surgical or conservative treatment? J Pediatr Urol 2014; 10:522-6. [PMID: 24321777 DOI: 10.1016/j.jpurol.2013.11.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/06/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To shed light on the current controversy regarding the best treatment option for managing urachal anomalies in children. PATIENTS AND METHODS A retrospective follow-up of a case series comprising 13 children who were diagnosed with urachal anomalies was performed. All cases were diagnosed between 2000 and 2011 and followed up at the Pediatric Urology Unit of San Cecilio University Hospital in Granada (Spain). Information about the baseline and follow-up variables was collected from clinical records. RESULTS Nine of the 13 patients were symptomatic (6 patients with urachal cysts and 3 patients with urachal persistency). Conservative management was originally used in all but one case. During follow-up, reinfection appeared in two cases, and these patients were treated surgically. Spontaneous resolution was achieved in eight cases (61.5%). Two children with persistent urachal cysts are still being followed (4 and 6 years after the diagnosis), although ultrasound monitoring reveals a gradual reduction in the size of the cysts. The median time between diagnosis and resolution was 16.5 months. CONCLUSION With the exception of cases in which there is a clear indication for surgery (i.e. reinfection), a conservative approach based on regular monitoring may be useful.
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Affiliation(s)
- Mercedes Nogueras-Ocaña
- Unit of Pediatric Urology, Department of Urology, San Cecilio University Hospital, Granada, Spain.
| | | | | | - Antonio Jiménez-Pacheco
- Unit of Pediatric Urology, Department of Urology, San Cecilio University Hospital, Granada, Spain
| | - Sergio Merino-Salas
- Unit of Pediatric Urology, Department of Urology, San Cecilio University Hospital, Granada, Spain
| | - Armando Zuluaga-Gómez
- Unit of Pediatric Urology, Department of Urology, San Cecilio University Hospital, Granada, Spain
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Naiditch JA, Radhakrishnan J, Chin AC. Current diagnosis and management of urachal remnants. J Pediatr Surg 2013; 48:2148-52. [PMID: 24094971 DOI: 10.1016/j.jpedsurg.2013.02.069] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 01/30/2013] [Accepted: 02/27/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE The purposes of this study are to review our experience with patients who were found to have urachal remnants. We discuss their diagnosis and management and we also evaluate post-operative complications in our cohort of patients with this entity. METHODS We performed a retrospective review of all patients diagnosed with a urachal remnant (UR) between January 2006 and December 2010. Patient variables included age, gender, presenting symptoms and signs, diagnostic modality, and type of urachal remnant. Operative management, post-operative complications, and non-operative follow-up were abstracted. RESULTS We identified 103 pediatric patients with either a urachal cyst (n = 38), urachal diverticulum (n = 13), urachal sinus (n = 11), patent urachus (n = 21), or a non-specific atretic urachal remnant (n = 20). Seventy-eight patients had symptomatic URs. Thirty-four symptomatic patients underwent surgical excision of the UR and 44 symptomatic patients were observed. Eighteen URs were incidentally diagnosed in asymptomatic patients, none of whom underwent surgical excision. In 7 patients symptoms could not be determined from the records. No patients with non-specific atretic remnants were operated upon. Nineteen of the observed patients were reimaged subsequently. In fifteen (78.9%) of these patients, the URs had resolved spontaneously. None of the patients who were observed required subsequent excision of the UR. Post-operative complications occurred in 14.7% of patients in whom URs were excised. CONCLUSION Review of our patients diagnosed with URs indicates there is a subset of patients in whom spontaneous resolution could be expected. Complications are not uncommon after surgical excision.
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Affiliation(s)
- Jessica A Naiditch
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Metwalli ZA, Guillerman RP, Mehollin-Ray AR, Schlesinger AE. Imaging features of intravesical urachal cysts in children. Pediatr Radiol 2013; 43:978-82. [PMID: 23370693 DOI: 10.1007/s00247-013-2628-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 12/14/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Urachal cysts, part of the spectrum of congenital urachal anomalies, are typically extrinsic to the urinary bladder. OBJECTIVE The purpose of this study is to present the salient imaging features of a pediatric series of unusual intravesical urachal cysts that protrude into the bladder lumen. MATERIALS AND METHODS Five children with intravesical urachal cysts depicted on imaging studies were retrospectively identified during a 6-year period at a children's hospital. The clinical charts and findings on ultrasound (US) and voiding cystourethrogram (VCUG) were reviewed. RESULTS In all five children, US revealed a thin-walled ovoid cystic structure containing anechoic fluid or echogenic debris and residing along the midline of the anterosuperior aspect of the urinary bladder protruding into the bladder lumen. Histological examination of the partial cystectomy specimen from one child revealed a cystic urachal remnant with intestinal mucosal lining and reactive lymphoid hyperplasia. The cysts in the four other children were managed conservatively without operative intervention. CONCLUSION The purpose of this report is to expand the spectrum of urachal remnant anomalies to include these newly recognized intravesical urachal cysts, which are characterized on US by the presence of a thin-walled cyst along the midline anterosuperior aspect of the urinary bladder.
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Affiliation(s)
- Zeyad A Metwalli
- Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA.
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A colo-urachal-cutaneous fistula in an 88-year-old male. Int J Surg Case Rep 2012; 3:55-8. [PMID: 22288045 DOI: 10.1016/j.ijscr.2011.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 10/10/2011] [Accepted: 10/12/2011] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Urachus anomalies are remnants of the urachus, an embryonic connection between the fetal bladder and umbilicus. These anomalies usually remain asymptomatic but can cause symptoms in case of infection. An extremely rare complication of symptomatic urachal remnants is fistulizing to adjacant viscera. We describe the first case of diverticulitis associated sigmoid-urachal-cutaneous fistula. CASE REPORT An 88-year-old male visited the outpatient clinic with intermittent bleeding and gassy discharge from his umbilicus. Examination showed a normal looking umbilicus with a small fissure at the bottom in which a 10 cm probe could be inserted. Laparotomy revealed a fistula extending from the umbilicus to a pus filled cyst superior to the bladder. A second fistula between the cyst and a mid-sigmoid diverticulum was identified. The involved sigmoid segment was resected. Pathological examination demonstrated no malignancy. DISCUSSION Urachal remnants are extremely rare in adults. They typically present with abdominal pain or palpable masses. Additional imaging can aid the diagnostic process. CONCLUSION Due to the risk of recurrence and malignant transformation complete surgical excision of urachal anomalies is the treatment of choice. This can be done in a 1-step or 2-step procedure.
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Gupta N, Corbett H, Ismail R, Sathanantharajah R, Sivakumar S, McCarthy L. Allantoic cyst - an unusual umbilical cord swelling. J Surg Case Rep 2011; 2011:5. [PMID: 24950576 PMCID: PMC3649232 DOI: 10.1093/jscr/2011.4.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We report a baby with an unusual umbilical cord swelling. On the antenatal scans, a cystic area within the umbilical cord near its insertion onto the abdominal wall was detected. Postnatally an unusually thick umbilical cord with a yellow fluid filled cyst at the base was noted. The fluid from the cyst was confirmed as urine and ultrasound confirmed patent urachus. The baby underwent a cystoscopy and excision of patent urachus with associated allantoic cyst. Allantoic cyst is a rare swelling formed at the base of umbilicus associated with a patent urachus which results from an allantoic remnant. Paediatricians need to be aware about this condition as investigation is required to differentiate allantois cysts from umbilical pseudocysts. A patent urachus with allantoic cyst requires surgical excision.
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