The role of sonography in the diagnosis and management of urachal abscesses

Wan, Yung‐Liang; Lee, Tze‐Yu; Tsai, Ching‐Chou; Chen, Shyr-Ming Sheen; Chou, Fong‐Fu

doi:10.1002/jcu.1870190403

Cited by 7 publications

(4 citation statements)

References 26 publications

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“…Demonstration of an abscess within the extraperitoneal fat space of the abdominal wall and extension to the umbilicus with or without umbilical discharge is a clue to the diagnosis of urachal abscess [18]. Both US and CT can be used to direct a fine-needle aspiration biopsy [19].…”

Section: Discussionmentioning

confidence: 99%

Abscess of urachal remnants presenting with acute abdomen: a case series

et al. 2012

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IntroductionUrachal diseases are rare and may develop from a congenital anomaly in which a persistent or partial reopening of the fetal communication between the bladder and the umbilicus persists. The most frequently reported urachal anomalies in adults are infected urachal cyst and urachal carcinoma. The diagnosis of this entity is not always easy because of the rarity of these diseases and the atypical symptoms at presentation. Imaging techniques, such as ultrasonography and computed tomography have a significant role in recognizing the presence of urachus-derived lesions.Cases presentationsCase presentation 1: A 25-year-old Arab-Berber man presented with a 10-day history of progressive lower abdominal pain accompanied by fever, vomiting, and low urinary tract symptoms to our emergency department. Laboratory data revealed leucocytosis. The diagnosis of an acute peritonitis was made initially. Abdominal ultrasonography revealed a hypoechoic tract from the umbilicus to the abdominal wall, and the diagnosis was rectified (infected urachal remnants). The patient was initially treated with intravenous antibiotics in combination with a percutaneous drainage. Afterwards an extraperitoneal excision of the urachal remnant including a cuff of bladder was performed. The histological analysis did not reveal a tumor of the urachal remnant. Follow-up examinations a few months later showed no abnormality.Case presentation 2: A 35-year-old Arab-Berber man, without prior medical history with one week of abdominal pain, nausea and vomiting, associated with fever but without lower urinary tract symptoms visited our emergency department. Laboratory data revealed leucocytosis. Abdominal ultrasonography was not conclusive. Computed tomography of the abdomen was the key to the investigation and the diagnosis of an abscess of urachal remnants was made. The patient underwent the same choice of medical-surgical treatment as previously described for case one, with a good follow-up result.Case presentation 3: A 22-year-old Arab-Berber man, with no relevant past medical history, presented to our emergency department because of suspected acute surgical abdomen. Physical examination revealed umbilical discharge with erythema and a tender umbilical mass. Abdominal ultrasonography and computed tomography scan confirmed the diagnosis of infected urachal sinus. Initial management was intravenous antibiotics associated with a percutaneous drainage with a good post-operative result, but a few days later, he was readmitted with the same complaint and the decision was made for surgical treatment consisting of excision of the infected urachal sinus. The clinical course was uneventful. Histological examination did not reveal any signs of malignancy.ConclusionsWe describe our clinical observations and an analysis of the existing literature to present the various clinical, radiological, pathological and therapeutic aspects of an abscess of urachal remnants. To the best of our knowledge, this manuscript is an original case report because this atypical p...

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Section: Discussionmentioning

confidence: 99%

Abscess of urachal remnants presenting with acute abdomen: a case series

et al. 2012

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“…We hypothesise that, due to trauma or another reason, the cyst may have attached to a lesion on the spleen, indicated by the scar observed. Also, there is the possibility of cyst rupture with adhesion to other structures, as previously reported [22,23].…”

Section: Discussionmentioning

confidence: 65%

Urachal Cyst in a Bitch

Hertel

Silva

Evangelista

et al. 2019

Acta Scientiae. Vet.

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Background:The urachus is a tubular structure continuous with the urinary bladder and the allantois in foetal mammals. It serves as a communication between these two structures. At birth, it loses its function and undergoes atrophy by fibrous proliferation within the lumen. When this atrophy process fails at some point, congenital anomalies of the urachus occur. These anomalies are rare in animals, and to our knowledge, the urachal cyst has not yet been described in dogs. The present work is unique in that it reports a case of this congenital defect in a dog. Our aim is to increase awareness and to discuss the clinical presentation, the imaging techniques used, and the final diagnosis of this anomaly. Case: A 3-year-old bitch Pit Bull was presented for veterinary assistance to investigate recurrent pseudopregnancy and an irregular estrous cycle. The animal presented in good bodily condition, and the white blood count and clinical biochemistry were normal. At ultrasound, 2 tubular structures, filled by an echogenic fluid mimicking uterine topography, were found extending through the umbilical and hypogastric regions. No alterations in structure, echogenicity or echotexture of the other organs were observed, including the ovaries and uterus. On exploratory laparotomy, a cystic structure was found, with 2 segments: the larger one was on the left side, attached to the apex of the bladder by its caudal portion; the other was on the right side, attached to the spleen by its cranial portion and to the apex of the bladder by its caudal portion in connection with the left segment. The ovaries, uterus and uterine horns showed no macroscopic alterations. The structure was removed, and after analysis (macroscopic morphology, wall histopathology and biochemistry of the contained fluid), it was determined to be a urachal cyst. The animal recovered uneventfully. Discussion: Ultrasound is an important tool for the evaluation of reproductive cycle physiology and its pathologies. At first, the owner's complaint justified a fairly straightforward evaluation and clinical management of pseudopregnancy in a very healthy animal based on the history and clinical and complementary exams. However, ultrasound examination revealed two tubular structures filled with echogenic fluid in the lower abdomen. This made the case more complex, as these were interpreted as uterine horns by three different veterinarians, leading to the possibility of pyometra. The management of this condition must be cautious, since the animal's condition could rapidly deteriorate, necessitating an exploratory laparotomy. Based on the clinical presentation, macroscopic anatomy, fluid biochemistry and histological evaluations, the diagnosis of urachal cyst was proposed. Congenital anomalies occur when the urachus fails to obliterate. Four types can be found: patent urachus, urachal sinus, urachal diverticulum and urachal cyst. The urachal cyst occurs when the urachus encompasses a cyst-like structure that is closed to the umbilicus and the bladder lumen. The urachus be...

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“…This remnant is described as an elliptical, hypoechoic structure that is located posterior to the rectus abdominis and anterosuperior to the bladder [ 10 ]. If an abscess is seen within the extraperitoneal fat space of the abdominal wall and extending to the umbilicus, it is a clue for the diagnosis of urachal abscess [ 11 ]. Therefore, the ultrasound has a high diagnostic accuracy and is considered the initial recommended test in diagnosing both omphalitis and urachal remnants [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Omphalitis with Umbilical Abscess in an Adult with a Urachal Remnant

Tawk¹,

Abdallah²,

Meouchy³

et al. 2021

Case Rep Gastroenterol

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Omphalitis is an inflammation of the umbilicus and is seldom diagnosed in adults. It is even rarer when it results from an infection of the urachus, an embryological remnant that connects the umbilicus to the dome of the bladder. Patients with omphalitis present with erythema, edema, tenderness, and purulent discharge form the umbilical stump. Workup includes ultrasonography and CT scan of the abdomen and pelvis. Management consists of antibiotics and incision and drainage of the umbilical abscess, followed by surgical resection of the urachal remnant. In this article, we report a case of omphalitis complicated by umbilical abscess in a 20-year-old female with a urachal remnant.

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The role of sonography in the diagnosis and management of urachal abscesses

Cited by 7 publications

References 26 publications

Abscess of urachal remnants presenting with acute abdomen: a case series

Abscess of urachal remnants presenting with acute abdomen: a case series

Urachal Cyst in a Bitch

Omphalitis with Umbilical Abscess in an Adult with a Urachal Remnant

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