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Medicina (Kaunas, Lithuania) Nov 2022Patent urachus is a type of urachal anomaly in which the urachus does not tail off but remains connected to the bladder in the umbilicus. The prevalence of patent... (Review)
Review
Patent urachus is a type of urachal anomaly in which the urachus does not tail off but remains connected to the bladder in the umbilicus. The prevalence of patent urachus is very low. Herein, we report a case of patent urachus ruptured and exposed to amniotic fluid in utero. In this case, the size decreased after the second trimester, which was thought to be due to rupture in utero. After delivery, patent urachus was confirmed by inserting a foley catheter, which runs through a ruptured cyst on umbilical cord insertion. The day after delivery, the neonate underwent surgical excision of the urachal cyst and closing umbilicus. The mechanism of patent urachus rupture is unknown. As the fetus matures, it is thought that the higher intravesical pressure may affect the rupture of the cyst. Patent urachus could be ruptured in the uterus spontaneously, and surgical correction is needed. Therefore, prenatal differential diagnosis is important.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Urachus; Urachal Cyst; Pregnancy Trimester, Second; Urinary Bladder; Ultrasonography, Prenatal
PubMed: 36363578
DOI: 10.3390/medicina58111621 -
Cureus Sep 2022During the development of the coelomic cavity, there is accessible communication between the urinary bladder and the umbilical wall through the urachus. Persistence of...
During the development of the coelomic cavity, there is accessible communication between the urinary bladder and the umbilical wall through the urachus. Persistence of this tract results in urachal pathologies with variable symptoms. We present a case of an infected urachal cyst presenting as an umbilical mass with clear discharge in a 19-year-old male successfully managed laparoscopically.
PubMed: 36304378
DOI: 10.7759/cureus.29371 -
Pediatric Surgery International Nov 2022It has been suggested that symptomatic UA requires surgical excision. However, the management of asymptomatic urachus is still controversial. We aimed to evaluate the...
PURPOSE
It has been suggested that symptomatic UA requires surgical excision. However, the management of asymptomatic urachus is still controversial. We aimed to evaluate the clinical presentation, the efficacy of current modalities used, and postoperative pathology in patients with UA.
MATERIALS AND METHODS
We have performed a retrospective review of all patients diagnosed with UA and treated surgically or conservatively over 18 years. Demographic data, clinical presentation, imaging modalities, pathology, treatment, and postoperative complications were analyzed.
RESULTS
Twenty-five symptomatic patients (18 males and seven females) with a median age of 13 years (1 month to 37 years) were identified. 15 (60%) were diagnosed with a urachal cyst, 4 (16%) with sinus, 3 (12%) with urachal diverticulum, and the remaining 3 (12%) with patent urachus. Of those, 20 (80%) underwent surgical repair, and the remaining five (20%) patients were managed conservatively. 4 (20%) underwent laparotomy, 7 (35%) laparoscopic incision, and the remaining 9 (45%) laparoscopic robotic-assisted surgery. Nine patients required bladder cuff excision. The median operative time was 75 min (42-140 min). One patient developed Clavien-Dindo grade IIIA complication resulting in infected hematoma, which resolved after drainage. Another patient with a complication of grade IIIB needed reoperation as a result of recurrent events of an abscess. 13 (65%) demonstrated epithelium lining of the urachus on postoperative pathology.
CONCLUSIONS
Our data show that most of the patients with UA presented with epithelial lining, which might lead to the later malignant transformation. It might cause a shift from the conservative management of asymptomatic patients to surgical intervention. Robotic-assisted surgery appears beneficial in these patients, especially when the bladder cuff excision is required.
Topics: Adolescent; Female; Humans; Laparoscopy; Male; Retrospective Studies; Robotic Surgical Procedures; Urachal Cyst; Urachus
PubMed: 35969254
DOI: 10.1007/s00383-022-05194-z -
Pediatric Surgery International Oct 2022The aim of this study was to elucidate the prevalence of urachal remnants in children in relation to patient age as well as to identify their anatomic variants, using a...
PURPOSE
The aim of this study was to elucidate the prevalence of urachal remnants in children in relation to patient age as well as to identify their anatomic variants, using a laparoscopic view.
METHODS
The medical records of 394 pediatric patients who underwent laparoscopic inguinal hernia repair were reviewed. Patients were divided into four groups based on their age at surgery. Using laparoscopic visualization, the presence and anatomic variants of urachal remnants were analyzed.
RESULTS
A urachal remnant was confirmed in 140 children (35.5%). Although the prevalence was significantly higher in the group of children aged < 1 year (63.2%) than in any other group, no significant difference in the prevalence was observed between the groups aged ≥ 1 year. In 42 cases (10.7%), the urachal remnant merged into the lateral umbilical ligament.
CONCLUSIONS
Our results suggest a recommendation of nonoperative management of asymptomatic urachal remnants, especially in patients less than 1 year of age due to its probable spontaneous resolution. Knowledge of the anatomic variants could improve the accuracy of diagnosis of urachal remnants and the comprehension of its structure and localization for the achievement of accurate and complete excision.
Topics: Child; Humans; Laparoscopy; Medical Records; Prevalence; Retrospective Studies; Urachal Cyst; Urachus
PubMed: 35879470
DOI: 10.1007/s00383-022-05183-2 -
ANZ Journal of Surgery Mar 2023
Topics: Humans; Infections; Urachal Cyst; Umbilicus; Intraabdominal Infections
PubMed: 35869968
DOI: 10.1111/ans.17924 -
International Journal of Surgery Case... Aug 2022Urachus is an embryonic remnant that usually involutes before birth. Abnormal persistence of this structure gives embryologic malformation like an urachal cyst....
INTRODUCTION
Urachus is an embryonic remnant that usually involutes before birth. Abnormal persistence of this structure gives embryologic malformation like an urachal cyst. Infection or malignancy degeneration can complicated it.
CASE PRESENTATION
Case 1: We report 20 years old female patient consulted with acute abdominal pain. Clinical examination showed fever and infra-umbilical tender mass. The abdominal Computerized Tomography showed pelvic mass between umbilicus and bladder. The open laparotomy found infra-abdominal semi-solid mass. A complete resection was done and histological exam confirmed infected urachal cyst. Case 2: A 19 years old male patient presented with abdominal pain and fever. Physical examination found tenderness in lower abdomen. Biology revealed leukocytosis, and Ultrasonography found a heterogeneous infra-umbilical mass. Surgical exploration by mini-laparotomy found an abscess urachal cyst that is confirm by histological exam after complete resection.
CLINICAL DISCUSSION
Urachal cyst in adult patient is rare. Clinical symptoms without complications are insignificant. Because of malignancy risk, adult urachal cyst are managed by surgery.
CONCLUSION
Infection cyst is the most common complication of urachal cyst. Complete resection is recommended because of malignancy degeneration risk.
PubMed: 35834928
DOI: 10.1016/j.ijscr.2022.107394 -
Clinical Practice and Cases in... May 2022A seven-year-old male presented to the pediatric emergency department with one day of abdominal pain. His physical exam was significant for rebound, guarding, and...
CASE PRESENTATION
A seven-year-old male presented to the pediatric emergency department with one day of abdominal pain. His physical exam was significant for rebound, guarding, and tenderness in the right lower quadrant, and his labs demonstrated a leukocytosis. Both a point-of-care ultrasound and radiology-performed ultrasound were concerning for acute appendicitis with a periappendiceal abscess, but on emergent laparoscopy the patient was found to have an infected urachal cyst.
DISCUSSION
Infected urachal remnants are a rare but important cause of pediatric abdominal pain. In this case, inflammation surrounding the patient's midline urachal cyst triggered a serositis that involved the appendix and pulled the cyst to the right. This created a clinical and radiologic presentation similar to appendicitis. This atypical presentation of an already rare anomaly highlights the importance of maintaining a broad differential during the work-up of pediatric abdominal pain.
PubMed: 35701355
DOI: 10.5811/cpcem.2022.1.55243 -
Medicine May 2022A patent urachus is a rare congenital anomaly that atypically presents as an umbilical cord cyst or large umbilical cord. Here we describe a case of a giant umbilical...
RATIONALE
A patent urachus is a rare congenital anomaly that atypically presents as an umbilical cord cyst or large umbilical cord. Here we describe a case of a giant umbilical cord cyst in a newborn diagnosed as a patent urachus.
PATIENT CONCERNS
A male infant with a birth weight of 3260 g was transferred because of an antenatally diagnosed giant umbilical cord cyst accompanied by yellowish discharge and granulation in the umbilical cord after birth.
DIAGNOSES
Patent urachus.
INTERVENSIONS
The patent urachus was treated by excision of the urachal remnant followed by partial cystectomy.
OUTCOMES
Postoperative orchitis with pyocele occurred and was treated with a course of antimicrobial therapy; and no other complications developed.
LESSONS
Newborns with a giant umbilical cord or umbilical cord cysts should be examined for possible accompanying urachal anomalies, even if antenatal ultrasound shows no other suspicious findings, to prevent delayed diagnosis and subsequent complications.
Topics: Communicable Diseases; Cysts; Female; Humans; Infant; Infant, Newborn; Male; Musculoskeletal Diseases; Pregnancy; Ultrasonography, Prenatal; Umbilical Cord; Urachus; Urinary Bladder
PubMed: 35608419
DOI: 10.1097/MD.0000000000029187 -
Journal of the College of Physicians... May 2022The urachal cyst, a remnant of allantois sac during embryogenesis, is a rare condition in adulthood. Urachus is an embryologic remnant degenerating after birth....
The urachal cyst, a remnant of allantois sac during embryogenesis, is a rare condition in adulthood. Urachus is an embryologic remnant degenerating after birth. Abberrant obliteration of the urachus causes urachal abnormalities. The urachal cysts are almost always symptomatic when infected. The symptoms include fever, abdominal pain, tenderness, lower abdominal mass, nausea, vomiting, and dysuria. Ultrasonography, computerised tomography, and magnetic resonance imaging techniques may be insufficient for diagnosis. In most cases, staphylococcus species are isolated from cultures of urachal cysts. Other microorganisms such as Escherichia coli, Enterococcus faecium, Klebsiella pneumonia, and rarely actinomyces may be isolated. Actinomyces, an anaerobic gram-positive filamentous bacterium, is a rare cause of granulomatous disease. In this case report, a 56-year woman with urachal cyst infection with actinomyces is discussed according to current knowledge. Key Words: Urachal cyst, Urachus, Chronic cystitis, Actinomyces.
Topics: Actinomycosis; Adult; Female; Humans; Klebsiella Infections; Male; Middle Aged; Urachal Cyst; Urachus; Urinary Tract Infections
PubMed: 35546708
DOI: 10.29271/jcpsp.2022.05.668 -
Revista Espanola de Patologia :... 2022The urachus is a thick fibrous cord that appears in the fifth month of pregnancy as a result of the allantois obliteration. Urachal cysts occur as a result of a defect...
The urachus is a thick fibrous cord that appears in the fifth month of pregnancy as a result of the allantois obliteration. Urachal cysts occur as a result of a defect in the obliteration of the duct, anomaly detected mainly in children and very rarely in adults. We present three cases of urachal cysts in adults, one of them detected during the study of abdominal pain and the other two, found incidentally during the study of other pathologies. In any case the possibility of urachal cysts was clinically suspected. Histologically, these lesions are lined by epithelium of urothelial type with expression of CK7, CK20, CK5/6, P63 and GATA3. The diagnosis of urachal cysts certainty lies in the histopathological study where the morphology, immunohistochemistry and a proper clinical-pathological correlation, allow to differentiate it from other more frequent abdominal cystic lesions in adults.
Topics: Adult; Child; Diagnosis, Differential; Epithelium; GATA3 Transcription Factor; Humans; Urachal Cyst
PubMed: 35483769
DOI: 10.1016/j.patol.2019.07.003