A colo-urachal-cutaneous fistula in an 88-year-old male

Abstract

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.

Urachal‐sigmoid fistula managed by laparoscopic assisted high anterior resection, primary anastomosis and en bloc resection of the urachal cyst and involved bladder

“…Although conservative, non‐surgical measures are not recommended for adult patients, there is no general consensus on the ideal operation for SUF. Surgeons previously paired excision of the urachal remnant with an open sigmoid resection and primary sigmoid anastomosis , an open sigmoid resection and a Bouilly‐Volkmann's colostomy , an open sigmoid resection with a Hartmann's colostomy , and a laparoscopic assisted sigmoid resection and primary sigmoid anastomosis . This case is unique as anterior resection was employed as part of the en bloc resection.…”

“…Although some studies suggest that diverticulitis is the primary cause of SUF in adults with diverticular disease, SUF is also known to involve normal colon, and an alternative pathogenesis is primary infection and subsequent fistulization of a urachal cyst into adjacent sigmoid colon. Adenocarcinomas are also common in urachal remnants, and are probably secondary to metasplasia due to chronic infection . Although conservative, non‐surgical measures are not recommended for adult patients, there is no general consensus on the ideal operation for SUF.…”

“…Normally obliterated by the fifth week of gestation to form the median umbilical ligament, the urachus, if present, rarely fistulates in adults. Sigmoid-urachal fistula (SUF) is thus exceedingly rare and only a few cases have been reported in the world literature (1)(2)(3)(4)(5)(6)(7)(8)(9).…”

A Sigmoid-Urachal-Cutaneous Fistula after Acute Diverticulitis

“…The urachal rest may become infected or ruptured and fistulize to the adjacent organs (2). As a consequence of the diverticulitis episode, the sigmoid colon or peridiverticular abscess may adhere to the patent urachus and develop a colourachal fistula with feculent umbilical drainage, pneumaturia, and fecaluria; the colourachal fistula is very rarely reported in the present literature (1)(2)(3)(4)(5)(6).…”

Minimally Invasive Approach to Urachal Remnant in Obese Patient

“…The persistence of the urachal lumen manifests in several clinical presentations, of which recurrent periumbilical discharge is the most common [9], following by abdominal mass. Very rare other clinical scenarios have been described, including urachal carcinoma [10,11], colo-urachalcutaneous fistula [12] and small bowel obstruction [13]. Diagnosis of the persistent urachal remnant could be challenging and first of all requires a thorough history and physical examination [5].…”