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Faye P, Gueye M, Thiam O, Niasse A, Ndong A, Ndiaye M, Seye Y, Sarr I, Seck M, Toure A, Cisse M. Infected urachal cyst in an adult, report of two observations. Int J Surg Case Rep 2022; 97:107394. [PMID: 35834928 PMCID: PMC9403061 DOI: 10.1016/j.ijscr.2022.107394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Urachus is an embryonic remnant that usually involutes before birth. Abnormal persistence of this structure gives embryologic malformation like an urachal cyst. Infection or malignancy degeneration can complicated it. CASE PRESENTATION Case 1: We report 20 years old female patient consulted with acute abdominal pain. Clinical examination showed fever and infra-umbilical tender mass. The abdominal Computerized Tomography showed pelvic mass between umbilicus and bladder. The open laparotomy found infra-abdominal semi-solid mass. A complete resection was done and histological exam confirmed infected urachal cyst. Case 2: A 19 years old male patient presented with abdominal pain and fever. Physical examination found tenderness in lower abdomen. Biology revealed leukocytosis, and Ultrasonography found a heterogeneous infra-umbilical mass. Surgical exploration by mini-laparotomy found an abscess urachal cyst that is confirm by histological exam after complete resection. CLINICAL DISCUSSION Urachal cyst in adult patient is rare. Clinical symptoms without complications are insignificant. Because of malignancy risk, adult urachal cyst are managed by surgery. CONCLUSION Infection cyst is the most common complication of urachal cyst. Complete resection is recommended because of malignancy degeneration risk.
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Affiliation(s)
- P.M. Faye
- General Surgery department of Dalal Jamm Hospital, Dakar, Senegal,Corresponding author at: General Surgery department, Dalal Jamm Hospital, Dakar, Senegal.
| | - M.L. Gueye
- General Surgery department of Aristide Le Dantec Hospital, Dakar, Senegal
| | - O. Thiam
- General Surgery department of Dalal Jamm Hospital, Dakar, Senegal
| | - A. Niasse
- Surgery department of Matlaboul Fawzeyni Hospital, Touba, Senegal
| | - A. Ndong
- General Surgery, Gaston Berger University, Saint-Louis, Senegal
| | - M. Ndiaye
- General Surgery department of Aristide Le Dantec Hospital, Dakar, Senegal
| | - Y. Seye
- General Surgery department of Aristide Le Dantec Hospital, Dakar, Senegal
| | - I.S.S. Sarr
- General Surgery department of Aristide Le Dantec Hospital, Dakar, Senegal
| | - M. Seck
- General Surgery department of Aristide Le Dantec Hospital, Dakar, Senegal
| | - A.O. Toure
- General Surgery department of Aristide Le Dantec Hospital, Dakar, Senegal
| | - M. Cisse
- General Surgery department of Dalal Jamm Hospital, Dakar, Senegal
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Isaev Y, Bertozzi M. Laparoscopic surgery of urachal remnants in children: 3-center experience and comparison to an open approach. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00180-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Since the first description by Trondsen in 1993, laparoscopy has become the preferred method of surgery of urachal remnants in children. Some authors call it the “gold standard.” Nonetheless, the comparison with open surgery in the literature is limited to several tens of patients. In this paper, we aim to summarize our experience reporting data of a large group of patients.
Results
We conducted a retrospective analysis of anonymized data from patients who underwent surgical interventions at three clinical centers. A total of 78 boys and 33 girls (M:F 2.36:1) were included in our study. Eighty-seven of them underwent mini-invasive surgery (group 1); 24 were operated in a conventional manner (group 2). The predominant form of the urachal anomaly found was the cyst (58.5%), while an umbilical sinus was present in 47 patients (42.3%), a bladder diverticulum in 7 (6.3%), and a patent urachus in 3 cases (2.7%). The average duration of surgery was 60.7 min (20–192 min) in group 1 and 42.7 min (20–90 min) in group 2; excluding the cases with simultaneous interventions, the average duration was found to be 54.5 and 39.7 min, respectively. Twenty-nine simultaneous operations for associated pathologies were performed in 19 cases (21.8%) in our MIS group, in 8 of them (9.19%) for a preoperatively unknown associated pathology, compared to 4 simultaneous operations performed in 4 patients (16.7%) in the open surgery group. We observed intra-operative complications in 2 cases in Group 1; early postoperative complications included hematuria in 14 cases (16%). The duration of postoperative analgesia was significantly shorter in the MIS group.
Conclusions
Laparoscopic surgery has better cosmetic results and allows for additional diagnostics and simultaneous operations that in turn lead to a shorter duration of postoperative analgesia, but has a longer duration in comparison to an open technique.
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Urachal anomalies: A review of pathological conditions, diagnosis, and management. TRANSLATIONAL RESEARCH IN ANATOMY 2019. [DOI: 10.1016/j.tria.2019.100041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Fujiogi M, Michihata N, Matsui H, Fushimi K, Yasunaga H, Fujishiro J. Early Outcomes of Laparoscopic Versus Open Surgery for Urachal Remnant Resection in Children: A Retrospective Analysis Using a Nationwide Inpatient Database in Japan. J Laparoendosc Adv Surg Tech A 2019; 29:1067-1072. [PMID: 31313966 DOI: 10.1089/lap.2019.0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: There was no large study that assessed the surgical safety of laparoscopic surgery (LS) for urachal remnant resection. This study compared early postoperative outcomes between LS and open surgery (OS) for pediatric urachal remnant resection, using a national inpatient database. Patients and Methods: Using the Diagnosis Procedure Combination database in Japan, we compared postoperative complications, duration of anesthesia, postoperative length of stay, and total hospitalization cost between LS and OS for children undergoing urachal remnant surgery from April 2015 to March 2017. Propensity score-adjusted analyses were performed for outcomes. Results: Among 882 eligible patients (306 LS; 576 OS), there were no significant differences between LS and OS for postoperative complications (odds ratio: 1.02; 95% confidence interval [CI]: 0.48-2.18; P = .96) and postoperative length of stay (difference: 0.14 day; 95% CI: -0.27 to 0.54; P = .39). Compared with OS, LS had significantly longer duration of anesthesia (difference: 51 minutes; 95% CI: 42-60; P < .001) and significantly higher total hospitalization cost (difference: US$824; 95% CI: 399-1249; P < .001). Conclusions: In this large nationwide cohort study, LS for urachal remnant resection was associated with longer duration of anesthesia and higher total hospitalization cost. However, no differences were detected between LS and OS regarding postoperative complications and length of stay. LS for urachal remnant resection is equivalent to OS in terms of surgical safety.
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Affiliation(s)
- Michimasa Fujiogi
- 1Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,2Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- 3Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- 2Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- 4Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- 2Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Jun Fujishiro
- 1Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Hassan S, Koshy J, Sidlow R, Leader H, Horowitz M. To excise or not to excise infected urachal cysts: A case report and review of the literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Parada Villavicencio C, Adam SZ, Nikolaidis P, Yaghmai V, Miller FH. Imaging of the Urachus: Anomalies, Complications, and Mimics. Radiographics 2016; 36:2049-2063. [DOI: 10.1148/rg.2016160062] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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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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Masuko T, Uchida H, Kawashima H, Tanaka Y, Deie K, Iwanaka T. Laparoscopic Excision of Urachal Remnants Is a Safe and Effective Alternative to Open Surgery in Children. J Laparoendosc Adv Surg Tech A 2013; 23:1016-9. [DOI: 10.1089/lap.2013.0127] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Takayuki Masuko
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Yujiro Tanaka
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kyoichi Deie
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, University of Tokyo Hospital, Tokyo, Japan
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Chouhan M, Cuckow P, Humphries PD. Utility of diffusion-weighted imaging in the presurgical diagnosis of an infected urachal cyst. Pediatr Radiol 2011; 41:125-8. [PMID: 20711571 DOI: 10.1007/s00247-010-1792-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 05/20/2010] [Accepted: 06/21/2010] [Indexed: 10/19/2022]
Abstract
Urachal cysts are one of a spectrum of urachal abnormalities that occur following failure of regression of the allantois and presumptive bladder between 4 weeks and 6 weeks of gestation. Infection is the most common complication of this rare congenital anomaly. The nonspecific presentation may mimic other pathological processes, underlining their clinical and radiological significance. Imaging investigations typically include US and CT, both of which are limited in their ability to characterize lesions. We report the case of a 5-year-old presenting with macroscopic haematuria in whom diffusion-weighted MRI (DWI) suggested the diagnosis of an infected urachal cyst, which was confirmed surgically. We discuss the radiological findings in multiple imaging modalities and present the application of DWI in this context as a means of improving the radiological diagnostic yield.
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Affiliation(s)
- Manil Chouhan
- Department of Radiology, University College London Hospital, London, UK
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Nozaki T, Ichimatsu K, Ito T, Yasuda K, Watanabe A, Fuse H. Laparoscopic excision of symptomatic urachal anomalies: a technique to restore the natural appearance of the umbilicus. J Laparoendosc Adv Surg Tech A 2010; 20:821-4. [PMID: 21105768 DOI: 10.1089/lap.2010.0318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent reports on laparoscopic surgery for urachal anomalies have not described any techniques to restore the natural appearance of the umbilicus. In this report, we present a simple technique that enables complete resection of urachal anomalies while preserving the natural appearance of the umbilicus. MATERIALS AND METHODS Laparoscopic excision of symptomatic urachal anomalies was performed for 4 men and 2 women. After dissecting the urachal lesion along the preperitoneal plane toward the umbilicus, the cephalic side of the lesion was ligated and the skin at the base of the umbilicus was divided while compressing the anterior abdominal wall to ensure complete removal of the lesion. RESULTS The laparoscopic procedure was successfully completed with minimal blood loss, and the umbilicus could be restored to its natural appearance in all the cases. CONCLUSIONS This is the first report to describe a procedure for restoring the natural appearance of the umbilicus. This simple, alternative approach yields better cosmetic results and, therefore, will be useful, especially in younger patients.
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Affiliation(s)
- Tetsuo Nozaki
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan.
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Sun J, Zhu YJ, Shi CR, Zhao HT, He R, Liu GH. Laparoscopic Radical Excision of Urachal Remnants with Recurrent Infection in Infants. J Endourol 2010; 24:1329-32. [PMID: 20629568 DOI: 10.1089/end.2009.0141] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jie Sun
- Department of Urology, Shanghai Children's Medical Center, Shanghai, China
| | - Ying Jian Zhu
- Department of Urology, Shanghai First People's Hospital, Shanghai, China
| | - Cheng Ren Shi
- Department of Pediatric Surgery, Xin Hua Hospital, Shanghai, China
| | - Hai Teng Zhao
- Department of Urology, Shanghai Children's Medical Center, Shanghai, China
| | - Rong He
- Department of Urology, Shanghai Children's Medical Center, Shanghai, China
| | - Guo Hua Liu
- Department of Urology, Shanghai First People's Hospital, Shanghai, China
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Ng DCK, Yau KKK, Li MKW. Laparoscopic excision of infected urachal cyst: Illustration of technique. SURGICAL PRACTICE 2010. [DOI: 10.1111/j.1744-1633.2010.00493.x] [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]
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