Treatment of infected urachal cysts

Diffuse peritonitis secondary to urachal cyst abscess in a postpartum patient

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.

A Very Rare Disease of Patent Urachus Cyst With Vesico-Umbilical Urinary Fistula in Adults: A Case Report and Short Review

Rare developmental anomalies known as urachal remnants are brought on by flaws in the foetal developmental process. However, depending on the location and degree of incomplete obliteration, the urachus can undergo a variety of urachal anomalies. An umbilical fistulogram and a voiding cystourethrogram both supported the existence of the adult urachal cyst in this case. To treat the sepsis, we provided the patient with antibiotics first, then a surgical procedure. The entire vesico-umbilical tract with the urachal cyst was removed using the open approach. The excised specimen's histology revealed a foreign body giant cell reaction without any indication of malignancy. The presentation and diagnosis of vesico-umbilical urinary fistula (VUUF) in adults can occasionally be difficult. They happen very rarely. So we began putting forward this case for the same reason.

An Unusual Case of Urachal Cyst Misdiagnosed as a Paraovarian Cyst: Ultrasound Assessment and Differential Diagnosis

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.

Infected urachal sinus with de novo stone and peritonism in a young athlete adult: A case report

INTRODUCTION AND IMPORTANCE

Urachal cyst (UC) sinus occur secondary failed regression of allantois's embryonal canal during fetal development. Several types depending on the arrest level and connection to the urogenital tract. Umbilical urachal sinus is characterized in less than 15 % of cases. An infected urachal sinus patient can present with umbilical sinus and purulent discharge with various emergency presentations and scenarios.

CASE PRESENTATION

A 26-year-old Sudanese male, a healthy athlete, presented two weeks before the last presentation with periumbilical discomfort, and umbilical discharge increased with physical activity. He was first seen in the outpatient clinic and diagnosed with an uncomplicated umbilical cyst. One week later, periumbilical pain became throbbing, severe with a dragging sensation, and skin erythema. His swelling produced purulent discharge with concomitant low-grade fever. He denied any past medical, surgical, or family history. An ultrasound scan revealed a periumbilical cyst confirmed by CECT consistent with an infected urachal sinus. Surgical excision of the cyst and umbilicoplasty was achieved with an uneventful postoperative course.

CLINICAL DISCUSSION

Urachal sinuses may vary in their presentation according to the anomaly and clinical effect. It can be daunting to diagnose, even with the availability of CECT modalities. Conservative management can be of benefit in case of incidental findings, but surgical management is the preferred approach for complicated patients. A laparoscopic approach is the recommended treatment.

CONCLUSION

Our case report shows that serious complications can be prevented with early diagnosis, management, and prompt surgical intervention if this rare diagnosis is kept in mind.

Rare case of umbilical urachal sinus mimicking infected umbilical abscess: A case report

Incomplete obliteration of urachus during the fetal period can lead to urachal abnormalities. One of these abnormalities is the urachal sinus that can be asymptomatic, or it can be symptomatic by becoming infected or being malignant, and it can mimic other diseases' symptoms. Although it is rare in adults, it should be considered a significant differential diagnosis in patients with abdominal pain or umbilical discharge. This article presents a young patient with urachal sinus mimicking umbilical pilonidal sinus symptoms.

A Rare Case of Urachal Cyst in a Patient With Uterine Fibroids

A 41-year-old woman presented to the emergency department with pain in her abdomen during menstruation. On examination, we detected a cystic lump in the midline, just below the umbilicus. Ultrasonography of the whole abdomen was suggestive of uterine fibroids with a probable mesenteric cyst. Computed tomography of the abdomen confirmed an otherwise asymptomatic, silent, urachal cyst connected to the umbilicus and urinary bladder by obliterated bands. The cyst was explored and removed surgically under combined spinal-epidural anesthesia, following a single-staged approach. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was subsequently performed. Urachal cysts are rare congenital anomalies. Any unexpected finding on clinical examination should alert clinicians for further evaluation and treatment.

Identification of an Infected Urachal Cyst Using Point-of-Care Ultrasound

ABSTRACT

This case describes a 6-year-old girl who presented to the pediatric emergency department with 3 days of fever and suprapubic pain in the setting of 1 month of worsening, dull abdominal pain. On presentation, she had a tender, erythematous, and fluctuant mass on her lower abdomen. Point-of-care ultrasound was used to identify an abnormal fluid collection anterior to her bladder, suspicious for an infected urachal cyst. In this case, point-of-care ultrasound helped identify this uncommon finding in a timely fashion, which expedited definitive care and prevented unnecessary exposure to ionizing radiation.

[Infected urachal cyst in an adult manifests as urosepsis]

The following is a case of an 81-year-old male adult who presented to our emergency department with signs of urosepsis. The patient came with an indwelling urinary catheter due to benign prostatic hyperplasia. Extended diagnostic investigation demonstrated an infected urachal cyst as the cause of infection, which was surgically treated.

Unexpected finding of urachal remnant cyst. Tips for laparoscopic approach

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Urachal cyst is a common anomaly related to the incomplete obliteration of the urachal lumen.

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This condition, per se asymptomatic, is not without risk.

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In symptomatic cases, the main approach is the laparoscopic excision.

Introduction

Incomplete obliteration of the urachal lumen could cause different types of anomalies and urachal cyst is the most common among these in the adult population. It is usually asymptomatic and may be an incidental finding during a surgical exploration for other reasons. However, it can be subject to complications.

Presentation of case

A 38-year-old female patient with history of worsening lower-quadrants abdominal pain, associated with fever and chills, presented to emergency room; clinical examination revealed a painful, tender, and fixed lump to the left inferior abdominal quadrant. Ultrasound reveled a left adnexal mass and, along the midline, between the adnexal mass, the bladder and the uterus, was evident a 3-cm unilocular cyst with regular walls and hypoechoic content. MRI confirmed the suspicion of a left tubo-ovarian abscess and suggested a diagnosis of urachal remnant for the smaller midline cyst. In this report, we describe the step-by-step laparoscopic management of the case, paying attention to “the tips and tricks” for urachal cyst excision.

Discussion

The urachal cyst, which results from the accumulations of secretions in urachal remnant, presents as a single or multiple parietal abdominal mass, per se asymptomatic. However, this condition is not without risk and infection represents the most common complication. Ultrasound is very useful in the diagnostic phase. Today, the main approach has become laparoscopic excision, with particular attention to a radical removing of the mass, due to high recurrence rate and the risk of malignancy.

Conclusion

In our experience, laparoscopy represents an excellent diagnostic and therapeutic tool for urachal cyst, especially for patients with acute urgent conditions, doubtful clinical history, and no clear signs or symptoms.

Laparoscopic surgery for urachal remnants in pubescent children: a case series

BACKGROUND

Various techniques are applied in laparoscopic surgery for the treatment of urachal remnants, which are less invasive and associated with lower morbidity. We herein report a case series in which we treated urachal remnants and medial umbilical ligaments using a laparoscopic approach.

CASE PRESENTATION

From 2015 to 2019, seven patients (male, n = 5; female, n = 2) with a urachal remnant were treated by laparoscopic surgery in our institute. Five boys and two girls with a median age of 11 years (range 10-15 years) were enrolled in this series. The clinical results of laparoscopic treatment, the perioperative records, and the pathologic results were evaluated. The operation was performed with the use of three ports and an EZ access® (Hakko Medical, Nagano, Japan), which is a silicon cap for the wound retractor (Lap Protector®, Hakko Medical, Nagano, Japan). The removal of the urachal remnant and medial umbilical ligaments was completed with a median operative time of 92 min (range 69-128). The median hospital stay after surgery was 4 days (range 2-5). No patients developed intra-postoperative complications or recurrence.

CONCLUSIONS

Although our data are preliminary, complete laparoscopic removal of symptomatic urachal remnants and medial umbilical ligaments was a safe and effective minimally invasive approach, with better cosmetic outcomes.

An infected urachal cyst presenting as acute abdominal pain in a child: A case report

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.

Imaging of urachal anomalies

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.

The primary considerations and image guided diagnosis of an infected urachal cyst in a pediatric patient

Urachal cyst is a rare condition that is typically asymptomatic and will often have symptomatology that is misdiagnosed or missed. A urachal cyst occurs in 1 out of 5000 live-births, but is only clinically relevant in 1 out of 150,000 of the population often as an incidental finding. The urachus is the embryological remnant of the allantois, which connects the apex of the bladder to the umbilicus, and usually fully obliterates to become the median umbilical ligament. Urachal defects are uncommon and cysts are usually asymptomatic until infection results. An infected cyst may present mimicking a wide range of intra-abdominal and pelvic disorders, and accurate diagnosis is often delayed. Children may present with umbilical discharge; adults often have hematuria. Computed tomography (CT) and ultrasound are ideally suited for demonstrating urachal remnant diseases; however, infected urachal cysts commonly display increased echogenicity with ultrasoundsography and thick-walled cystic or mixed attenuation with CT. Drainage and excision of the urachal remnant is the definitive treatment.

Infected urachal cyst in an adult: A case report

The urachus is an embryologic remnant which degenerates after the birth. An infected urachal cyst is one of a spectrum of presentations of urachal pathology, all of which are rare in adulthood. Infected urachal cyst is a rare pathology in adult women and it should be considered in the differential diagnosis of acute abdomen. We report here a case of a 50-year-old women with an infected urachal cyst reveled by an acute abdomen.

Urachal abscess mimicking malignant tumor: can imaging tell them apart?

The urachus is an embryonic remnant that usually involutes before birth. Abnormal persistence of this structure can lead to infectious or neoplastic complications later in life. We report a case of an 84-year-old man that presented with a urachal complex mass which, after proper investigation, revealed to be a urachal abscess. Urachal abscesses are rare and usually occur in severe infections. Urachal abscesses can be indistinguishable from urachus carcinoma on imaging studies. This article reviews the clinical and imaging aspects of urachal abscess and carcinoma and possible differentiating elements in imaging. However, definitive diagnosis usually depends on a biopsy or fluid aspiration.

Acute abdomen due to an infected urachal cyst in a 5-year-old female: case report

The urachus is an embryonic tube that connects the upper portion of the bladder to the umbilicus, and obliterates normally during embryonic development stages forming the median umbilical ligament. Incomplete obliteration of this tube results in many anomalies such as congenital patent urachus, umbilical urachal sinus, vesicourachal diverticulum and urachal cyst. We report in this case a 5-year-old female presented to the Emergency, complaining of generalized abdominal pain, fever, vomiting, and constipation with no umbilical discharge. The clinical presentation accompanied by radiology investigations suggested a case of acute abdomen. We performed an exploratory laparotomy and found a mass above the bladder connected to the umbilicus; we excised the mass and sent a specimen to pathology that confirmed Urachal cyst. Urachal cyst is usually asymptomatic unless it is complicated; depending on our case, we recommend surgical management by complete excision for complicated urachal cyst.

Surgical management for an infected urachal cyst in an adult: Case report and literature review

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.

Cured by Da Vinci Xi: meticulous dissection of an infected urachal cyst presenting with lower urinary tract symptoms in an adult

An unusual finding in an adult patient with an infected urachal cyst, was treated surgically using the Da Vinci robot. A 26-year-old woman was admitted to our hospital with complaints of lower abdominal pain and burning sensation with urination. She was diagnosed with lower urinary tract infection, treatment did not help her symptoms and further evaluation of CT revealed complex enhancing mass superior to the urinary bladder. The differentials included inflammatory cause such as an abscess, neoplastic mass, urachal cyst, vitello intestinal fistula and urachal sinus. Da Vinchi robotic diagnostic laparoscopy was performed to obtain an accurate assessment and treatment. After cystoscopy followed by laparoscopic exploration of the abdominal and pelvic cavity further helped to narrow down a diagnosis of remnants of urachus. Pathology of the excised specimen showed inflammation without evidence of malignancy and confirmed Urachal cyst. The patient had an uneventful post-operative course.

Urachal cyst with xanthogranulomatous cystitis: A rare case report

An urachal cyst is a sinus remaining from the allantois during embryogenesis which is rarely manifested in adults. The urachus is an embryologic remnant which degenerates after the birth. Defective obliteration of the urachus leads to urachal abnormalities. Urachal cyst is a rare pathology in adult women, and this pathology should be considered in the differential diagnosis of acute abdomen. Xanthogranulomatous cystitis (XC) is a benign disease of unknown etiology. The clinical manifestations of these are nonspecific such as lower abdominal pain, umbilical discharge with occasional hematuria. Urachal lesions present with persistent umbilical drainage in infants and newborn. However, in 35% cases, enclosed urachal cyst or infected urachal cyst (abscess) manifests without having umbilical discharge. Computed tomography scan and magnetic resonance imaging are of little help to the identification of these preoperatively. Here, we present a rare case of urachal cyst with XC in 30-year-old female which has produced diagnostic dilemma.

Infected Urachal Cyst in an Adult: A Laparoscopic Approach

Urachal cysts occur infrequently in adults and are rarely reported in the literature. Laparoscopic excision or robot-assisted laparoscopic excision of urachal cysts has widely been applied in recent years. We present a case of urachal cyst infection treated with antibiotics and two-staged operation. The laparoscopic procedure was performed without any complications. Strong suspicion is the key for early diagnosis.

Infected urachal remnants: an unusual presentation

The urachus is the remnant of the cloaca and allantois, and attaches the umbilicus to the bladder dome. Urachal anomalies are symptomatically identified during childhood. It rarely occurs in adults, making diagnosis difficult. We present and discuss the case of an infected patent urachus in a 30-year-old male.

An Infected Urachal Cyst in an Adult Woman

The urachus is an embryologic remnant which degenerates after the birth. Defective obliteration of the urachus leads to urachal abnormalities. An infected urachal cyst is one of the urachal abnormalities and this pathology is rare in adult women. We report a case of 33-year-old woman with pelvic pain and dysuria who was diagnosed with infected urachal cyst. Infected urachal cyst is a rare pathology in adult women and this pathology should be considered in the differential diagnosis of acute abdomen.

Infected urachal cyst in a young adult

The urachus is the remnant of the cloaca, which in adults attaches the bladder dome to the umbilicus. After birth it obliterates and presents as the midline umbilical ligament. Patent urachal anomalies are usually detected in childhood. In adults they occur very rarely and the presentation and diagnosis may be occasionally challenging. We present and discuss the case of an infected urachal cyst found in a 30–year–old adult.

Urachal anomalies in children: surgical or conservative treatment?

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.

An infected urachal cyst presenting as an acute abdomen - A case report

INTRODUCTION

An infected urachal cyst is one of a spectrum of presentations of urachal pathology, all of which are rare in adulthood.

PRESENTATION OF CASE

We report the case of a 45-year-old obese Russian lady who presented with a 2-week history of suprapubic pain radiating to the right iliac fossa. Although previously fit and well, she had a history of 17 miscarriages. Both USS and CT suggested a complicated inflammatory mass in the lower abdomen. Ultimately the diagnosis was made by laparotomy, which revealed an abscess of an urachal cyst. The infected cyst and bladder dome were excised. The patient made a good recovery with an uneventful follow up.

DISCUSSION

Urachal cysts are the commonest type of urachal anomaly. Infection is the usual mode of presentation amongst adult cases otherwise the condition usually remains asymptomatic. An infected urachal cyst is an important diagnosis to make as complications include sepsis, fistula formation, and rupture leading to peritonitis. Treatment is by complete excision, however, techniques have been debated.

CONCLUSION

This is a rare but important diagnosis however we recommend that in patients with atypical histories, it should be included in the differential diagnosis.

An infected urachal cyst

Urachal cysts present very uncommonly in adults. We describe a 25-year-old man who attended with a discharging umbilical swelling and pain. Ultrasonography and CT scan demonstrated an infected urachal cyst which, following cystoscopy, was excised without complication.

Unique Presentation of Urachal Cyst Disease: Incidental Finding to Complicated Infection

Urachal remnant disease is uncommon in adults and can present with symptoms ranging from drainage near the umbilicus to a severe abdominal infection. Most cases are referred for treatment once diagnosed either clinically or radiographically with ultrasound or computerized tomography. We present a unique case of an infected urachal cyst visualized on a series of CT scans in an adult patient with abdominal pain over a period of years.

Pyourachus in spina bifida: case report and review

Failure of the urachus to close results in a multitude of clinical anomalies. Such anomalies have been documented as occurring in association with mechanical bladder outlet obstruction. However, no urachal anomalies have been linked specifically to spina bifida. Two cases of urachal abscesses were identified in adolescent male patients with spina bifida at our institution, both with neuropathic bladders and using self-catheterization. The clinical presentations differed, with classic involvement of the umbilicus in 1 case. Because of its varied presentations, the diagnosis of a urachal anomaly is potentially difficult. Urachal anomalies should be considered in the evaluation of pelvic masses in this demographic.

Nonoperative management of symptomatic urachal anomalies

INTRODUCTION

Symptomatic urachal anomalies are rare disorders that consist of urachal remnants or fistulas with or without an associated cyst. Traditionally, when a urachal anomaly was recognized, operative excision was performed. There has been a shift toward the nonoperative management of urachal anomalies at many centers, although there is little in the literature to support this practice.

METHODS

A retrospective chart review of patients with urachal anomalies was performed from January 2002 to March 2008. Children with a draining umbilicus and no radiographic or surgical confirmation of a urachal anomaly were excluded.

RESULTS

Fifteen patients with symptomatic urachal anomalies were identified. The average age was 3.5 years (4 weeks to 14 years). Symptoms included umbilical drainage (n = 10), abdominal pain (n = 6), omphalitis (n = 4), intraabdominal mass (n = 3), dysuria (n = 1), recurrent urinary tract infections (n = 1), and fever (n = 4). The diagnosis was confirmed by ultrasound (n = 13) and/or computed tomographic scan (n = 4). The surgically treated cases included 7 urachal cysts (5 uninfected, 2 infected) and 1 patent urachal fistula. Mean follow-up is 37 months, and there have been no reported recurrences. Those treated without surgical excision included 4 patent urachal fistulas (mean follow-up, 20 months-no recurrences) and 3 infected urachal cysts (percutaneous drainage [n = 2] and laparoscopic drainage [n = 1]-no recurrences on ultrasound at 26 months).

CONCLUSION

Nonoperative management of urachal anomalies is a reasonable approach and may be extended to infected urachal cysts after initial drainage. Infected cysts that are adequately drained seem to obliterate with time. Modern ultrasonography facilitates thorough follow-up. We propose a treatment algorithm for the management of suspected urachal anomalies.

Infected urachal cyst in an adult: a case report and review of the literature

INTRODUCTION

Urachal cyst is one of a spectrum of urachal abnormalities most commonly found in children. They are very rarely seen in adults because the urachus is normally obliterated in early infancy.

CASE PRESENTATION

We describe a case of a 32 year old male Caucasian who presented with a tender, midline, infraumbilical mass and purulent umbilical discharge. Diagnosis of an infected urachal cyst was confirmed on magnetic resonance scan. He was treated initially with broad spectrum antibiotics in order to allow sepsis to resolve prior to surgical excision of the cyst and fibrous tract. Cystoscopy was performed intraoperatively to exclude sinus communication with the bladder. Histology of the excised specimen showed chronic inflammation with no evidence of malignancy. Postoperative recovery was uneventful.

CONCLUSION

Urachal abnormalities are rare in adults. Clinical presentation is non-specific; therefore, a high index of suspicion is required in order to make the diagnosis. When diagnosed, surgical excision is advised because of the risk of malignant transformation.

Sigmoid-urachal-cutaneous fistula in an adult male

An infected urachal cyst is an uncommon finding in adults. We report the first case of a sigmoid-urachal-cutaneous fistula that resulted from rupture of an infected urachal cyst in an adult male. Definitive management consisted of resection of the urachus with a bladder cuff, along with removal of the affected bowel segments and bowel anastomosis.

Abscess formation as a complication of a ruptured urachal cyst

The urachus is a midline tubular structure that extends upward from the dome of the bladder toward the umbilicus. This tubular structure normally involutes before birth, remaining as a fibrous band with no known function. Persistence of all or any portion of the fetal urachus results in several anomalies, the most common of which is the urachal cyst (Yu JS, Kim KW, Lee HJ, Lee YJ, Yoon CS, Kim MJ, Radiographics, 21:451-4611, 2001; Ohgaki M, Higuchi A, Chou H, Takashina K, Kawakami S, Fujita Y, Hagiwara A, Yamagishi H, Surg Today, 33:75-77, 2003). Although most urachal cysts are asymptomatic, there are a few reports about intraperitoneal rupture of infected urachal cysts, all of which caused peritonitis and sepsis (Ohgaki M, Higuchi A, Chou H, Takashina K, Kawakami S, Fujita Y, Hagiwara A, Yamagishi H, Surg Today, 33:75-77, 2003; Kojima Y, Miyake O, Taniwaki H, Morimoto A, Takahashi S, Fujiwara I, Int J Urol, 10:174-176, 2003; Agatstein EH, Stabile BE, Arch Surg, 119:1269-1273, 1984). We report the imaging and operative findings of a patient, presented with a urachal abscess after a spontaneously ruptured urachal cyst.