Urachal cyst presenting with huge abscess formation in adults

A large infected urachal mass in an adult: A case report in Tanzania

Introduction and importance

Urachal Mass results from a failure of obliteration of the urachal canal during fetal growth. The aetiology of urachal masses is ambiguous, being either of a cancerous or benign origin. Much literature is stipulated in children presenting with urachal-associated diseases but few in adult patients. This study aims at elucidating the existence of urachal mass with an abscess in a patient and the management modalities.

Presentation of case

We present a case report of a 52-year-old female patient with a two months history of abdominal pain and discomfort associated with intermittent low-grade fevers, anorexia and marked weight loss throughout her illness. An abdominal ultrasound revealed the presence of an intra-abdominal mass. A CT scan showed a multilobulated urachal mass. She eventually had a successful operation and quick recovery postoperatively.

Discussion

In the adult population, most urachal-associated diseases are malignant, with few being of benign origin. With different presentations between the two aetiologies, the most benign urachal masses may lead to infection and inflammation that typically present with a lower abdominal mass and fever. Diagnosis is made by ultrasound or CT scan of the abdomen. Surgical drainage and excision of the mass are the mainstay treatment modalities.

Conclusion

Urachal masses are rare in the adult population and are often missed in initial presentations. This will constitute poor management and outcome for patients. Physicians are to be alerted of the knowledge and make a clear assessment of patients perioperatively to avoid the delayed diagnosis, which may have consequent poor outcomes.

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Rarely, The Urachus may be retained as a failure of obliteration during fetal development.

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Associated retained urachal sinuses is a congenital anomaly that results in urachal abscesses.

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Urachus associated diseases are most commonly benign but may have a cancerous etiology.

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Poorly diagnosed patients result in poor prognosis. Early identification of the presentations with physical examinations, investigations and imaging is paramount.

Surveillance of urachal abscess in the Kyushu-Okinawa area of Japan

OBJECTIVE

To report a multicenter experience with the management of urachal abscess treatment in Japan.

METHODS

This was a retrospective study of 263 cases of urachal abscess managed at 12 university hospitals in the Kyushu-Okinawa region over a 10-year period. Age, sex, abscess size, clinical symptoms, type of urachal remnants, and treatment were collected and analyzed.

RESULTS

The average age was 29.8 ± 18.1 years, with males accounting for approximately two-thirds of the study population. The average abscess size was 1.7 cm (range 0-11 cm). The most common presenting symptom was umbilical secretion (66%), followed by abdominal pain (46%). A total of 127 patients (48.3%) were treated with antibiotics alone, whereas 136 patients (51.7%) received surgical treatment. The surgical approach was laparotomy in 75 patients (61.0%) and laparoscopic surgery in 48 patients (39.0%). Regarding the type of urachal remnant, the urachus sinus (180 patients) accounted for 68.4% of the total.

CONCLUSIONS

To our knowledge, this study represents the first report on urachal abscess treatment in Japan. Our data show that the clinical symptoms might vary depending on the type of urachus remnant. It should be noted that gross hematuria, a characteristic symptom of urachal cancer, is rare in patients with urachal abscess.

Urachal Sinus Complicated by an Umbilical Abscess

The urachal sinus is a vestigial remnant that ensues in the aftermath of incomplete obliteration of the embryonic urachus. Urachal sinuses often remain asymptomatic, being discovered incidentally in instances where they are complicated with a superimposed infection or abscess. Due to their rare occurrence in adults, urachal sinuses are rarely included in the list of differential diagnosis surrounding umbilical pain in adult patients. We hereby delineate a unique case of a urachal sinus in a 26-year-old male patient. Due to the presence of an abscess in a hirsute male, a presumptive diagnosis of an umbilical pilonidal sinus was suspected. However, further diagnostic workup divulged an unequivocal diagnosis of a urachal sinus complicated by an abscess formation.