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Medicine Jun 2024Urachal anomalies are rare and can present with various clinical manifestations. Urachal remnants, in particular, can be difficult to diagnose because of atypical...
RATIONALE
Urachal anomalies are rare and can present with various clinical manifestations. Urachal remnants, in particular, can be difficult to diagnose because of atypical symptoms at presentation. This study reports a case of intestinal obstruction in an infant secondary to an infected urachal cyst.
PATIENTS CONCERNS
A 3-month-old boy with a known febrile urinary tract infection developed acute abdominal distension.
DIAGNOSES
Abdominal ultrasound (US) and computed tomography (CT) revealed a nonspecific, ill-defined soft tissue density at the mid-abdomen, associated with intestinal obstruction.
INTERVENTIONS
Emergency exploratory laparotomy was performed. The site of the obstruction was found to be at the mid-small bowel; the proximal small bowel was markedly distended, and the small bowel and sigmoid colon were adherent to urachal remnant. The urachal remnant was excised, and the peritoneal adhesions were lysed.
OUTCOMES
The day after surgery, the patient was discharged without any complications.
LESSONS
Intestinal obstruction is an exceedingly rare presentation of urachal remnants. This case highlights that urachal anomalies should be considered in the differential diagnosis in patients with intestinal obstruction and a concurrent febrile urinary tract infection.
Topics: Humans; Male; Urinary Tract Infections; Urachal Cyst; Infant; Intestinal Obstruction; Fever; Diagnosis, Differential; Ultrasonography
PubMed: 38875366
DOI: 10.1097/MD.0000000000038615 -
Clinical Case Reports May 2024Urachal anomalies are rare congenital lesions of the genitourinary tract and are important causes of pediatric and adolescent hospital presentations. It can mimic many...
Urachal anomalies are rare congenital lesions of the genitourinary tract and are important causes of pediatric and adolescent hospital presentations. It can mimic many other causes of intraabdominal pathology and fever, and pose diagnostic challenges, often aided by imaging, is crucial to prevent complications such as infection and calculus formation. Surgical intervention, preferably laparoscopic, is the primary treatment, with complete excision necessary to avoid potential malignant transformation.
PubMed: 38721562
DOI: 10.1002/ccr3.8896 -
Cureus Apr 2024Intrauterine devices (IUDs) are an effective method of contraception, with failure rates comparable to sterilization. In rare cases, IUDs can migrate to other sites,...
Intrauterine devices (IUDs) are an effective method of contraception, with failure rates comparable to sterilization. In rare cases, IUDs can migrate to other sites, including the bladder, cecum, and fallopian tubes. This case reports a 44-year-old woman who was misdiagnosed with a urachal cyst due to the migration of her IUD into the anterior abdominal wall. A laparoscopic retrieval was successfully performed. To prevent any further serious complications, it is imperative to promptly diagnose and manage migrated IUDs.
PubMed: 38707021
DOI: 10.7759/cureus.57637 -
International Journal of Surgery Case... May 2024Urachal cyst infections during pregnancy are exceptionally rare, posing diagnostic challenges. This case report contributes to the limited literature, emphasizing the...
INTRODUCTION AND IMPORTANCE
Urachal cyst infections during pregnancy are exceptionally rare, posing diagnostic challenges. This case report contributes to the limited literature, emphasizing the rarity, diagnostic difficulties, and the need for heightened healthcare provider awareness for timely intervention.
PRESENTATION OF CASE
A 32-year-old pregnant woman with persistent pelvic pain, fever, and urinary symptoms sought care with inconclusive initial diagnoses despite multiple ER visits. Labor revealed a palpable mass, and postpartum, a CT scan identified a urachal cyst abscess. Urgent laparoscopy confirmed peritonitis, leading to cyst removal, antibiotics, and a subsequent laparotomy. Histology confirmed an abscessed urachal cyst.
DISCUSSION
Urachal cyst infections in pregnancy, exceptionally rare and diagnostically challenging, highlight the importance of considering them in abdominal pain differentials. Diagnostic tools, such as ultrasound and CT scans, can be misleading, emphasizing the necessity for a multidisciplinary approach.
CONCLUSION
This case report underscores the challenges in diagnosing and managing an infected urachal cyst during pregnancy, stressing the need for awareness and a comprehensive diagnostic approach for optimal outcomes. The rarity of such cases warrants increased attention within the medical community.
PubMed: 38579600
DOI: 10.1016/j.ijscr.2024.109584 -
Folia Medica Cracoviensia Dec 2023The urachus is a tubular structure that is apparent on the third week and connects the ventral cloaca to the yolk sac, as a progression from the allantois. Following the...
The urachus is a tubular structure that is apparent on the third week and connects the ventral cloaca to the yolk sac, as a progression from the allantois. Following the normal regression procedure, the urachus remains as the median umbilical ligament. Urachal remnants are present in 1.03% of paediatric patients while in 92.5% of cases represent incidental findings. Urachal anomalies are classified in four types as patent urachus (50-52%), urachal sinus (15%), urachal cyst (30%) and urachal diverticulum (3-5%). Ultrasound scan is the most commonly performed diagnostic imaging study. In case of symptomatic urachal remnants, surgical excision is indicated. Asymptomatic urachal remnants that are diagnosed at the neonatal period or early infancy should be watched up to 6 months of age, as they are likely to resolve. In persistent or symptomatic urachal remnants there is a risk of inflammation or even malignancy development, therefore we believe that there is indication for preventive surgical excision that may be performed either open or laparoscopically or by robot-assisted laparoscopy.
Topics: Infant, Newborn; Humans; Child; Urachus; Urachal Cyst; Ultrasonography; Laparoscopy; Inflammation
PubMed: 38578347
DOI: 10.24425/fmc.2023.148760 -
Cureus Jan 2024Urachal anomalies and their associated disease processes are quite rare in pediatric populations and even rarer in adults. Although often asymptomatic, patients with...
Urachal anomalies and their associated disease processes are quite rare in pediatric populations and even rarer in adults. Although often asymptomatic, patients with symptoms can be treated with a combination of surveillance, antibiotics, and sometimes surgical resection. In this case, we describe our experience using the single-port robotic approach for the excision of a symptomatic urachal remnant. The patient presented with a chief complaint of urinary frequency, dysuria, intermittent hematuria, and right flank pain. A CT scan of the abdomen and pelvis revealed a bladder wall thickening at the dome of the bladder measuring 2.6 x 3.6 x 1.5 cm with concerns for adenocarcinoma. The patient subsequently underwent a biopsy, which was benign. The patient's symptoms persisted, and she elected to undergo surgical resection. Postoperatively, her symptoms resolved, and she was satisfied with her treatment outcome. This case exemplifies the feasibility of the single-port robotic approach to urachal remnant excision, with further applicability to simple transabdominal robotic bladder surgery.
PubMed: 38425617
DOI: 10.7759/cureus.53235 -
Urology Case Reports Mar 2024The urachus is an embryologic remnant that connects the bladder to the umbilicus and typically obliterates during gestation. Urachal cysts are one of the most common...
The urachus is an embryologic remnant that connects the bladder to the umbilicus and typically obliterates during gestation. Urachal cysts are one of the most common congenital urachal anomalies. Urachal cysts may be found incidentally on imaging or present as a palpable mass with abdominal pain and fever. We present a case of a young male with a urachal cyst who presented with lower urinary tract symptoms and a falsely elevated post void residual (PVR) volume on bladder scan. This case illustrates an atypical presentation of a large urachal cyst and highlights the limitations of bladder scanner post-void residual determination.
PubMed: 38292565
DOI: 10.1016/j.eucr.2024.102655 -
Experimental and Therapeutic Medicine Dec 2023Mucinous cystic tumors of low malignant potential (MCTLMP) are rare urachal neoplasms. The morphological characteristics and clinical prognosis of MCTLMP is similar to...
Mucinous cystic tumors of low malignant potential (MCTLMP) are rare urachal neoplasms. The morphological characteristics and clinical prognosis of MCTLMP is similar to that of mucinous cystic tumors occurring in the ovary and appendix. After complete resection, almost no cases of recurrence or metastasis have been reported. Because MCTLMP is rare, it may be missed in the clinic. MCTLMP can lead to the formation of pseudomyxoma peritonei (PMP), which manifests as the widespread production of mucus in the abdominal cavity and makes the disease complex or difficult to diagnose. At present, only 3 cases of MCTLMP with PMP have been reported in the literature. In the present study a fourth case of urachal MCTLMP in a 74-year-old male that resulted in widespread PMP is presented. Initially, a multilocular cystic lesion was revealed in the urachal duct area at the anterior upper margin of the bladder after a patient, experiencing lower abdominal pain, was imaged. As revealed using light microscopy, the cyst was lined with a mucous columnar epithelium, and part of the epithelium indicated pseudolamellar hyperplasia and papillary structures. The cells indicated mild atypia and low mitotic activity. There was no stromal infiltration of tumor cells, and a large amount of mucous exudate was observed. As preoperative computed tomography examination suggested the presence of a large amount of ascites and there were increased levels of blood tumor markers, carcinoembryonic antigen and carbohydrate antigen 125, clinicians considered that the diagnosis maybe a malignant tumor of the urachal gland with peripheral dissemination. However, the diagnosis of MCTLMP with PMP was confirmed by histopathological examination. The mass was completely removed, along with part of the peritoneum and bladder wall as these were within the tumor margin. The appendix appeared normal during surgery. A one off dose of intraperitoneal infusion chemotherapy with 1,000 mg 5-fluorouracil was performed after surgery. No recurrence was observed during the 8-month follow-up period.
PubMed: 37941591
DOI: 10.3892/etm.2023.12254 -
Journal of Medical Case Reports Aug 2023Urinary bladder masses in children are extremely rare. Certain benign conditions (e.g., ureterocele) can mimic malignant bladder masses. In this report, we present a...
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.
Topics: Male; Child; Humans; Child, Preschool; Urachal Cyst; Urinary Bladder Neoplasms; Urinary Bladder; Cysts; Pelvis
PubMed: 37612773
DOI: 10.1186/s13256-023-04110-w -
Cureus Jul 2023Rare developmental anomalies known as urachal remnants are brought on by flaws in the foetal developmental process. However, depending on the location and degree of...
Rare developmental anomalies known as urachal remnants are brought on by flaws in the foetal developmental process. However, depending on the location and degree of incomplete obliteration, the urachus can undergo a variety of urachal anomalies. An umbilical fistulogram and a voiding cystourethrogram both supported the existence of the adult urachal cyst in this case. To treat the sepsis, we provided the patient with antibiotics first, then a surgical procedure. The entire vesico-umbilical tract with the urachal cyst was removed using the open approach. The excised specimen's histology revealed a foreign body giant cell reaction without any indication of malignancy. The presentation and diagnosis of vesico-umbilical urinary fistula (VUUF) in adults can occasionally be difficult. They happen very rarely. So we began putting forward this case for the same reason.
PubMed: 37551248
DOI: 10.7759/cureus.41503