Infected Urachal Cyst

Abstract

A 19-month-old girl with a history of myelomeningocele and Chiari malformation type II presented with abdominal pain. The initial abdominal examination was normal; however, within 24 hours, the umbilicus became protuberant and erythematous (Panel A). The white-cell count was elevated, with a large proportion of neutrophils. Computed tomography of the abdomen revealed a cystic mass, measuring 6.1 cm by 2.0 cm, which extended from the umbilicus to the dome of the bladder (Panel B, arrow). The mass had no connections with the bladder or umbilicus; therefore, it was diagnosed as an urachal cyst. Antibiotic agents were administered, and purulent material was drained from the infected cyst. Escherichia coli and coagulase-negative staphylococcus grew. Antibiotic treatment was tailored to these organisms. After drainage and a course of antibiotics, the urachal cyst was excised. The differential diagnosis for this condition includes patent urachus and a partial urachal remnant. A patent urachus connects the bladder and umbilicus, resulting in urinary drainage through the umbilicus; a partial urachal remnant connects the urachal sinus to the umbilicus or the urachal diverticulum to the bladder. More than 1 year after surgical correction, the patient had an apparently unrelated infraumbilical abscess requiring incision and drainage, but she has been otherwise well.

A novel extraperitoneal approach exploration for the treatment of urachal mass: a retrospective observational single-center study

“…Surgery should be the first choice for treatment because urachal cysts can be infected or become malignancies. 8,9 Traditional open surgery not only has long incisions, significant trauma, and obvious scars but also seriously damages the appearance of the umbilical. Since Trondsen 10 reported using laparoscopy to treat urachal cysts in 1993, many surgeons have tried to use laparoscopic surgery to treat urachal lesions.…”

Urachal remnant with heterotopic sinus in an adult male

“…[6–8] If there are some complications such as infection, the surgery should be performed after the infection is controlled. [9] During the surgery, we can inject methylene blue to identify the direction of the drainage. However, the diseased tissue must be completely removed.…”

Umbilicus-sparing laparoscopic versus open approach for treating symptomatic urachal remnants in adults

“…Spontaneous resolution with nonoperative management is likely for an urachal remnant in patients younger than 6 months. [ 11 , 12 ] By contrast, infection and malignant transformation are common complications of urachal remnants in adults, [ 3 , 13 ] and approximately 30% recurrence is seen when complicated urachal cysts are managed conservatively with drainage and antibiotic therapy. [ 4 , 14 ] Therefore, an operation is the preferred method for treatment.…”

“…[ 2 ] The most common form of urachal abnormalities in adults is a urachal cyst, and infection is the usual mode of acquisition. [ 3 ] Infected and symptomatic urachal remnants routinely require intervention, including antibiotics and drainage of the abscess cavity. [ 4 ] Drainage alone is inadequate because of possible recurrent infection and malignant transformation later in life.…”