Intravesical urachal cyst masquerading as a bladder malignancy: a case report

BACKGROUND

Urinary bladder masses in children are extremely rare. Certain benign conditions (e.g., ureterocele) can mimic malignant bladder masses. In this report, we present a unique case of a urachal cyst masquerading as a bladder malignancy. Unlike the typical location of urachal cysts along the course of the urachal tract, the cyst in this case was unexpectedly situated within the urinary bladder, leading to diagnostic difficulties.

CASE PRESENTATION

A 2-year-old Bahraini boy presented with hematuria and dysuria for 2 weeks. There was no history of fever, abdominal pain, or vomiting. Physical examination yielded normal findings. Urinalysis showed numerous red blood cells and revealed positive results for nitrites and leukocyte esterase. Abdominal ultrasound showed a well-defined soft tissue lesion with internal vascularity located at the apex of the urinary bladder. Subsequently, magnetic resonance imaging demonstrated a thick-walled cystic structure arising from the anterosuperior wall of the bladder and protruding into its lumen. The patient underwent complete excision of the bladder lesion for the presumed diagnosis of rhabdomyosarcoma. Histopathological examination showed a fluid-filled space lined by stratified squamous epithelium with areas of intestinal metaplasia, revealing an unexpected diagnosis of a urachal cyst. The patient was discharged with complete resolution of symptoms.

CONCLUSIONS

Intravesical urachal cysts are a rare type of congenital urachal anomaly that may simulate a bladder malignancy, particularly if associated with infection. This case emphasizes the importance of considering urachal cysts in the differential diagnosis of bladder masses, especially in children, and specifically when the lesion is midline in the anterosuperior wall of the bladder.

Posterior urethral valves and urachal cyst: an unusual combination

Combination of posterior urethral valves and urachus remnants has been described as rare occurrence. We report a case of a baby boy with normal antenatal scans, in whom the presence of large urachal cyst and posterior urethral valves causing high pressure bladder and chronic kidney disease was found. The patient underwent ablation of posterior urethral valves at 23 days of life and urachal cyst removal at age of 4 and a half months.

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.

An Unusual Case of Meckel Diverticulitis Misdiagnosed as an Infected Urachal Cyst

Introduction: Meckel’s diverticulum (MD), a remnant of the omphaloenteric duct, is among the most frequent intestinal malformations. Another embryonic vestige is the urachus, which obliterates, becoming the median umbilical ligament; the failure of this process can lead to a urachal cyst formation. We present a case of Meckel diverticulitis misdiagnosed as an infected urachal cyst. Presentation of case: A 16-year-old girl presented with hypogastric pain, fever and vomiting. She had undergone an appendectomy 6 years prior and no digestive malformation had been documented. In the last 2 years, she had 3 events of urinary tract infections with Escherichia coli, and anabdominal ultrasound discovered a 28/21 mm hypoechogenic preperitoneal round tumor, anterosuperior to the bladder. We established the diagnosis of an infected urachal cyst, confirmed later by magnetic resonance imaging. Intraoperative, we found MD with necrotic diverticulitis attached to the bladder dome. Discussions: Meckel’s diverticulum and urachal cyst (UC) are embryonic remnants. Both conditions are usually asymptomatic, being incidentally discovered during imaging or surgery performed for other abdominal pathology. Imaging diagnosis is accurate for UC, but for MD they are low sensitivity and specificity. For UC treatment, there is a tendency to follow an algorithm related to age and symptoms, but there is no general consensus on whether to perform a routine resection of incidentally discovered MD. Conclusion: Preoperatory diagnosis of MD represents a challenge. We want to emphasize the necessity of a thorough inspection of the small bowel during all abdominal surgical interventions and MD surgical excision regardless of its macroscopic appearance. These two actions seem to be the best prophylaxis measures for MD complications and consequently to avoid emergency surgery, in which case more extensive surgical procedures on an unstable patient may be needed.

The urachus revisited: multimodal imaging of benign & malignant urachal pathology

The urachus is a fibrous tube extending from the umbilicus to the anterosuperior bladder dome that usually obliterates at week 12 of gestation, becoming the median umbilical ligament. Urachal pathology occurs when there is incomplete obliteration of this channel during foetal development, resulting in the formation of a urachal cyst, patent urachus, urachal sinus or urachal diverticulum. Patients with persistent urachal remnants may be asymptomatic or present with lower abdominal or urinary tract symptoms and can develop complications. The purpose of this review is to describe imaging features of urachal remnant pathology and potential benign and malignant complications on ultrasound, CT, positron emission tomography CT and MRI.

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.

Ultrasound findings of urachal anomalies. A series of interesting cases

AIMS

This study's aim is to present the specific ultrasonography (US) findings of a series of urachus anomalies.

MATERIAL AND METHODS

Seven patients with suspected urachal anomalies underwent US scanning initially prior to the surgery and the features of images were reviewed respectively. The clinical data and pathologic results were collected also.

RESULTS

US successfully diagnosed urachal anomalies in 5 patients (5/7, 71.4%) and failed to diagnose in 2 patients (2/7, 28.6%). Patent urachus showed a tubule between the umbilicus and bladder; urachal sinus was a blind focal dilatation at the umbilical end, while vesicourachal diverticulum was an outpouching at the vesical end and urachal cyst was identified as an anechoic structure along the urachus. Non-enhancement in the base and centre was the distinct features of urachus carcinoma by contrastenhanced ultrasonography (CEUS). Using a high frequency probe and CEUS the diagnostic ability of US may be improved.

CONCLUSION

US showed good diagnostic ability in urachal anomalies and combined with CEUS could improve the differential diagnosis.

Prenatally diagnosed patent urachus with umbilical cord cyst and early surgical intervention

OBJECTIVE

Description of rare diagnosis of patent urachus.

DESIGN

Case report.

SETTING

Department of Obstetrics and Gynecology, 2nd Faculty of Medicine and Faculty Hospital Motol Prague.

CASE REPORT

Patent urachus is a rare diagnosis, which in this case was detected prenatally by ultrasound. Involution of the urachus is not fully completed upon birth, therefore in cases of small persisting communication between the urinary bladder and the umbilicus conservative approach and waiting for spontaneous closure is usually chosen. In our case surgery treatment has chosen as a prevention of urinary infection because of patent urachus manifested as a wide communication.

CONCLUSION

This congenital defect usually manifests itself early after birth as a visible structural anomaly of the umbilicus and/or as urine leakage in the umbilicus opening area. It is important to keep in mind that urachus irregularities may be accompanied by other urinary system defects. Every child presenting with such an anomaly should therefore be thoroughly examined. If the procedure is performed by an experienced surgical team postoperative complications are uncommon and overall long-term prognosis for patients is excellent.

Sonographic detection of an infected maternal urachal cyst during pregnancy

Infection of a maternal urachal cyst during pregnancy is rare; Sonography is an important diagnostic tool that can help minimize maternal and fetal complications. We describe the case of a 35-year-old multiparous woman presenting in the third trimester with 2 weeks of fever, abdominal pain, and urinary symptoms. Imaging showed a 5-cm complex anterior midline mass, found intraoperatively to be eroding into the uterus. Sonographic imaging aided in the diagnosis and management of the urachal cyst, and antepartum sonographic measurements of the lower uterine segment helped to counsel regarding a trial of labor. Following treatment, the patient stabilized and had an uncomplicated vaginal delivery.

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.

Umbilical cord cysts in the first trimester: are they associated with pregnancy complications?

OBJECTIVES

To determine whether umbilical cord cysts found by transvaginal sonography in the first trimester of pregnancy are associated with poor pregnancy outcomes.

METHODS

We conducted a matched cohort study between July 2006 and July 2008. Patients with umbilical cord cysts found on transvaginal sonography in the first trimester were matched to patients with normal umbilical cords. After the completion of these pregnancies, medical histories and pregnancy outcomes were reviewed from the hospital's electronic record. Sonograms were reviewed to obtain descriptive information about the umbilical cord cysts. Outcomes between the cohorts were compared.

RESULTS

Forty-five patients with umbilical cord cysts were identified and compared to 85 patients with normal umbilical cords. The mean gestational age of the cysts ± SD at diagnosis was 8 weeks 3 days ± 3.5 days. The mean cyst diameter was 3 ± 2.1 mm. All cysts resolved on follow-up sonography, which was performed between 9 weeks 4 days and 20 weeks 5 days. Patients with umbilical cord cysts were found to have a lower body mass index than those with normal umbilical cords. There was no significant difference in abnormal sonographic findings between cohorts. Five sonographic fetal abnormalities were found in the umbilical cord cyst cohort (11.1%) and 8 in the normal umbilical cord cohort (9.4%). There were 2 intrauterine fetal demises in the umbilical cord cyst cohort and 1 in the normal umbilical cord cohort. There was no difference between the cohorts when comparing gestational age at delivery and birth weight.

CONCLUSIONS

There does not appear to be an association between poor pregnancy outcomes and umbilical cord cysts during the first trimester.

[Tenesmus and stranguria in a heifer caused by a urachal cyst in the bladder wall]

A 10-month-old Brown Swiss heifer was referred to our clinic be- cause of pollakiuria, stranguria and tenesmus. Ultrasonography and endoscopy revealed a cyst-like lesion at the apex of the urinary bladder. The apex of the bladder was surgically removed with the patient in dorsal recumbency under general anaesthesia. Histological examination revealed a cyst lined with urothelium in the wall of the urinary bladder. The heifer was discharged 9 days after surgery. According to the owner's information the animal did not show any clinical signs 6 months later.

Outcomes of fetuses with umbilical cord cysts diagnosed during nuchal translucency examination

OBJECTIVES

The purpose of this study was to report the outcomes of fetuses with the finding of an umbilical cord cyst during nuchal translucency examination in a low-risk population.

METHODS

A retrospective study was conducted in a large tertiary referral academic center over a 3-year period. All fetuses with umbilical cord cysts during the nuchal translucency scan were recruited, and their medical data concerning the pregnancy and neonatal course were analyzed.

RESULTS

Eight fetuses (0.7%) had a diagnosis of an umbilical cord cyst among the 1080 nuchal translucency examinations. The mean cyst diameter was 19 mm (range, 10-38 mm). The male to female ratio was 6:2. Isolated umbilical cord cysts were found in 5 cases (62.5%), and in all, the nuchal translucency measured less than 2 mm; the cysts resolved; and the outcomes were normal. Three fetuses (37.5%) had additional associated malformations. In all of them, the cysts persisted during pregnancy. Two of them had increased nuchal translucency (3.2 and 4.2 mm). In these 2 cases, 1 fetus had a hypoplastic left heart with a normal karyotype, and the other had multiple malformations and trisomy18. Both pregnancies were terminated. The third case, with normal nuchal translucency, had an ectopic kidney and a patent urachus, which closed spontaneously at 23 weeks and resulted in a normal pregnancy outcome.

CONCLUSIONS

A favorable outcome is expected when an umbilical cord cyst diagnosed during late first trimester presents as an isolated finding associated with normal nuchal translucency and resolves later on.

Allantoic cysts and posterior urethral valves: a case report

Allantoic cysts are a somewhat rare entity. They are identifiable on antenatal ultrasound examination but are not easily distinguishable from pseudocysts, which are often associated with a poor prognosis. Their etiology remains obscure and obstructive uropathies have been proposed to be one of the underlying mechanisms. We report on a case in which both allantoic cysts and a patent urachus were detected antenatally and turned out to be associated with posterior urethral valves (PUV). The cysts were first seen in the early second trimester, with a full fetal bladder and patent urachus. They disappeared by the 29(th) week. During the subsequent sonographic examinations, the bladder was emptying regularly. The kidneys remained normal throughout the pregnancy. It is hypothesized that the increased pressure within the urinary tract kept the urachus patent, led to the formation of allantoic cysts and, later, to their perforation; this allowed the fetus to empty his bladder and kept him from the usual complications of PUV. This case emphasizes the importance of detection and characterization of umbilical cord cysts on antenatal ultasound examination and suggests that obstructive uropathies should be included in the differential diagnosis of umbilical cord cyst communicating with the fetal bladder.

An unique case of dyspareunia leading to the diagnosis of urachal cyst in a nulliparous 28-year-old woman

Urachal cysts are usually asymptomatic. Symptoms, when present, are usually acute abdominal pain, fever, midline hypogastric tenderness, palpable mass, evidence of urinary infection or haematuria due to infection of the cyst. We report an unique case of dyspareunia and "abdominal fluid flowing feeling" caused by an urachal cyst in a 28 year-old nulliparous woman. Diagnosis was achieved by US and MRI. Cystography excluded any cyst-bladder communication. Laparoscopic surgery was performed without perioperative complications. Patient obtained immediate relief of symptoms still continuing at a 24 months follow up.

Umbilical cord cysts in the second and third trimesters: significance and prenatal approach

OBJECTIVES

This study was carried out to determine the prognosis, and the clinical approach, in fetuses with umbilical cord cysts, during the second and third trimesters of gestation, according to our experience and data in the current literature.

METHODS

We identified 10 fetuses with umbilical cord cysts that were diagnosed during the second and third trimesters of pregnancy at three referral centers. All underwent detailed ultrasound evaluation at the time of diagnosis and during follow-up. Prenatal karyotype testing was offered to all women. A MEDLINE review of the literature published from 1980 to 2009 was carried out to identify previous studies and case reports of fetuses with umbilical cord cysts.

RESULTS

In our series of 10 cases, significant additional abnormalities were observed in two during a detailed sonogram. In one case, trisomy 18 was diagnosed, leading to pregnancy termination, and in the other case a neonate with heart defects and a normal karyotype was born. These results differ from those reported in the literature, in which the association between second- and third-trimester umbilical cord cysts and fetal anomalies ranged from 38 to 100%.

CONCLUSIONS

In our study, as in other publications, an association was found between the presence of second- and third-trimester umbilical cord cysts and fetal anomalies. The strong association between second- and third-trimester umbilical cord cysts and aneuploidy in the literature seems to be biased, mainly because of the tendency to report abnormal cases. When these findings are accompanied by additional sonographic abnormalities, the association with aneuploidy is clear and should be an indication for fetal karyotype testing.

Umbilical cord cysts: evaluation with different 3-dimensional sonographic modes

OBJECTIVE

The purpose of this series was to determine whether the use of different 3-dimensional (3D) sonographic modes allows better definition of umbilical cord cysts and pseudocysts in utero.

METHODS

Two cases of umbilical cord cysts and 1 of a pseudocyst were analyzed and compared with 2-dimensional (2D), 3D, angiopower Doppler, tomographic ultrasound imaging (TUI), virtual organ computer-aided analysis (VOCAL), and automatic volume calculation (AVC) sonographic modes. All cases were followed during pregnancy. A karyotype analysis was also obtained.

RESULTS

Three-dimensional sonography, TUI, and VOCAL allowed clear visualization and evaluation of the sizes, locations, and numbers of umbilical cord cysts. A clear differentiation between a pseudocyst and the yolk sac was obtained with AVC and angiopower Doppler sonography. The 3D sonographic surface mode allowed better visualization of other accompanying fetal malformations.

CONCLUSIONS

Three-dimensional sonography allows for a more accurate diagnosis and provides a clearer visualization of malformations than 2D imaging. Cysts and pseudocysts can be defined much more accurately by using the different modes described here.

Fetal death due to umbilical cord hematoma: A rare complication of umbilical cord cyst

We report two cases of an umbilical cord cystic mass detected by sonography in otherwise structurally normal second-trimester fetuses, which were later complicated by a cord hematoma and fetal death.

[Umbilical cord cyst--should it concern us?]

INTRODUCTION

Advancements in sonographic technology have led to improved prenatal detection of fetal umbilical cord and placental anomalies. The prevalence of umbilical cord cystic masses detected in the first trimester is 0.4% to 3.4%. The second- and third-trimester umbilical cord cysts are a rare sonographic finding and its prevalence is unknown. There is a strong association between umbilical cord cysts and fetal anomalies but not in all cases. The main questions are: what are the implications of these findings and what is the prenatal follow-up that should be offered.

CASE REPORT

In this study the authors present a case in which an umbilical cord cyst was diagnosed at 29 weeks of gestation following normal integrated test and anatomical sonographic survey. At 32 weeks of gestation, fetal karyotype was found to be normal. The outcome of the pregnancy was normal and so was the developmental follow-up during the first three years.

DISCUSSION AND CONCLUSIONS

From the literature survey it appears that transient first-trimester cysts are not associated with chromosomal anomaLies, yet they might be associated with congenital maLformations, especially those of the abdominal wall and the urinary tract, and should lead to further detailed sonographic evaluation. Routine karyotype may not be necessary. Second and third trimester umbilical cord cystic masses accompanied by additional malformations are strongly associated with chromosomal anomalies, especially with trisomy 18. Second- and third-trimester umbilical cord cystic masses without additional abnormal findings were also found to be associated with chromosomal anomalies in some works. Therefore, these findings should be an indication for fetal karyotype. In the case of an isolated umbilical cord cyst with normal karyotype, serial sonographic evaluation is needed. If all these are normal, it may be presumed that the cyst is an isolated umbilical cord anomaly and that the fetal prognosis is good.

Laparoscopic excision of a urachal cyst containing large stones in an adult

Stone-containing urachal cysts are extremely rare in adults. Here, we report the case of a 58-year-old man with a urachal cyst who had lower abdominal pain and urinary frequency. Abdominal ultrasonography and computed tomography showed hyperdense stones in the urachus. He was treated with a laparoscopic excision using a transperitoneal approach. The pathological diagnosis was an inflammed urachal cyst. This rare case illustrates an inflammed urachal cyst containing stones treated with laparoscopy.

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.

Treatment of infected urachal cysts

The urachus is a fibrous cord that arises from the anterior bladder wall and extends cranially to the umbilicus. Traditionally, infection has been treated using a two-stage procedure that includes an initial incision and drainage which is then followed by elective excision. More recently, it has been suggested that a single-stage excision with improved antibiotics is a safe option. Thus, we intended to compare the effects of the two-stage procedure and the single-stage excision. We performed a retrospective review on nine patients treated between May 1990 and September 2005. The methods used in diagnosis were ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and cystoscopy. The study group was comprised of three males and six females with a mean age of 28.2 years (with a range from three to 71 years). Symptoms consisted of abdominal pain, abdominal mass, fever, and dysuria. The primary incision and drainage followed by a urachal remnant excision with a bladder cuff excision (two-stage procedure) was performed in four patients. The mean postoperative hospitalization lasted 5.8 days (with a range of three to seven days), and there were no reported complications. A primary excision of the infected urachal cyst and bladder cuff (single-stage excision) was performed in the other five patients. These patients had a mean postoperative hospitalization time of 9.2 days (with a range of four to 15 days), and complications included an enterocutaneous fistula, which required additional operative treatment. The best method of treating an infected urachal cyst remains a matter of debate. However, based on our results, the two-stage procedure is associated with a shorter hospital stay and no complications. Thus, when infection is extensive and severe, we suggest that the two-stage procedure offers a more effective treatment option.

[Adult urachal cyst]

Urachal Cyst pathologies comprise lesions that arise at the medial infraumblical line which is rarely seen in an adult. It has interesting and varied forms of clinical presentations which represent a diagnostic challenge for the clinician. Persistency of the Urachus is due to failure of the normal obliteration process which occurs embriologically during the 4th gestational month. This gives way to a lesion that should be taken into account while considering the differential diagnoses of the cystic pathologies of the region. We present the case of an adult woman with a Urachal Cyst, which was surgically excised at the Hospital Interamericano de Medicina Avanzada in Caguas, Puerto Rico, followed by a brief literature review.

Umbilical cord cyst detected in the first trimester by two- and three-dimensional sonography

A case of umbilical cord cyst was identified via 2-dimensional and 3-dimensional sonographic examination at 8 weeks' menstrual age. The cyst was solitary, measuring 18.0 mm, and it was located close to the placental insertion on the umbilical cord. The gestational sac and yolk sac diameters and the fetal heart rate were within normal ranges for menstrual age. Follow-up 3-Dimensional sonographic examination in the second trimester showed complete resolution of the cyst. Amniocentesis revealed a normal karyotype, and a normal infant was delivered at term.

[Dermoid cyst of the urachus: a case report and review of the literature]

The urachus, a normal embryonic remnant of the primitive bladder dome, exists as a fibrous cord in adult. Urachal disorders are not exceptional, and are expression of incomplete regression. Diagnosis is generally ultrasonographic, rarely clinical. We report a case of urachal dermoid cyst revealed by abdominal pain and underline the diagnostic difficulties related to this unusual localization.

Staged approach to the urachal cyst with infected omphalitis

Embryonal urachus exists as a cord-like structure between the urinary bladder and the umbilicus. In some cases of urachal cysts at the level of the navel, no special symptoms are detected during childhood, but spontaneous drainage at the navel may occur after adolescence, which is called an infected urachal cyst. Especially in cases accompanied by infected omphalitis, no constant opinion has been established to choose either initially curative resection or staged incision. In this study, we evaluated the characteristics of patients with urachal cysts who underwent the staged approach. Twenty patients (14 men and 6 women) with urachal cysts complicated by infected omphalitis were treated in our hospital. Staged surgery was performed for 18 patients. Neither recurrent omphalitis nor subsequent urachal carcinoma was observed. It is desirable that urachal cyst accompanied by intractable omphalitis should be treated by conservative therapy, conducted image diagnosis, and chosen staged surgery.

[A urachus cyst revealing a torpid Crohn's disease in a young adult with chronic fever]

INTRODUCTION

This case report describes a rare situation in which a superinfected cyst of the urachus complicated initially unknown and inactive Crohn's disease.

CASE

A 21-year-old man presented a chronic fever finally attributed to a superinfected urachal cyst. Six months after ablation of the cyst, progressive Crohn's disease was diagnosed.

DISCUSSION

The association of Crohn's disease and a superinfected urachal cyst is extremely rare. The case reported here is original in two aspects: the slowly progressive Crohn's disease was diagnosed after its complication; the superinfection developed through local bacterial translocation (ileal loop adjacent to the urachal cyst).

[Infected urachal cyst]

The urachus is a vestigial remnant of the cloaca and allantois. It is usually obliterated at early postnatal life. When this obliteration is incomplete, in addition to congenital urachal anomalies such as patent urachus, umblical-urachal sinus, vesico-urachal diverticulum, and urachal cyst, acquired urachal pathologies as infections and neoplasms can emerge. In this case report we will evaluate an infected urachal cyst established in a 26 year-old female. She presented with complaints of abdominal pain and umblical discharge. suprapubic sensitivity, abdominal mass with an overlying hyperemic skin were detected. Patient whose clinical manifestations suggested the diagnosis of infected urachal cyst which was also supported by USG and CT findings was operated. Total cyst excision was performed.

Large pseudocyst of the umbilical cord associated with patent urachus

Cystic masses of the umbilical cord have been detected in the second and third trimesters of pregnancy in association with fetal abdominal wall defects and chromosomal anomalies. We present a case of an umbilical cord pseudocyst diagnosed using routine ultrasound at the 20 weeks of gestation. Serial sonography followed the progression of the cystic masses. A 2960-g male infant was delivered at term, in whom a patent urachus was detected. The infant underwent repair with closure of the patent urachus and plastic reconstruction of the abdominal wall, and the postoperative course was uneventful. This case demonstrated an uneventful outcome despite the persistent multiple cord cysts.

Umbilical cord edema associated with patent urachus

Umbilical cord anomalies can often be detected prenatally by ultrasound, but a definitive prenatal diagnosis is not always possible. We present a case with increasing edema of the Wharton's jelly followed by the development of pseudocysts in the proximal umbilical cord due to a patent urachus. The first abnormal findings were detected by ultrasound in the 14th week of gestation. Differential diagnoses and their influence on surveillance and birth management are discussed.

[Chronic fever revealing an urachal cyst]

In the adult, the urachus remains as a non-specific fibrous formation extended from the bladder dome to the Retzius space. This urachal remnant is commonly asymptomatic or may be revealed by a cyst. This later may also be asymptomatic or lead to local inflammation or inflammatory pseudo-tumor. We report an original observation of chronic fever revealing an urachal cyst in a 21-Year-old male.

Laparoscopic radical excision of urachal sinus

Persistent urachus is a rare congenital anomaly. Various types of remnants have been described including cyst, alternating sinus, patent urachus, diverticulum, and sinus. The most common presenting symptom of urachal sinus is umbilical discharge. Radical excision of the remnant, with or without a bladder cuff, is essential to prevent future malignant degeneration or recurrence of the remnant. Although open surgical excision has been the treatment of choice for many years, the laparoscopic approach has become an attractive alternative because of its association with less postoperative pain, better cosmesis, and rapid convalescence. Laparoscopic radical excision of a urachal sinus was performed in a 16-year-old female patient who presented with umbilical discharge.