Urachal Abnormality (Patent Urachus/Urachal Cyst/Sinus/Diverticulum)

A remnant of the umbilical arteries, urachus, is a transverse structure lying between the peritoneum and the fascia transversalis. Urachus results from the involution of the embryonic duct and the ventral cloaca. The Urachus drains the bladder of the fetus by running within the umbilical cord. Usually, during embryonic development, the urachal tract obliterates. Failure of complete obliteration of the urachus, which is reported to be present in approximately 30% of adults, can lead to several abnormalities of the urachus. Common abnormalities of the urachus include - urachal cyst, diverticulum, umbilical sepsis, or patent urachus. This is a case report of a 23 days old female neonate who presented to us with complaints of fever for 11 days and umbilical discharge for 4 days. Clinical, microbiological, and radiological examinations revealed patent urachus with Methicillin-resistant coagulase-negative staphylococcal (MR-CoNS) umbilical sepsis. It is a rare condition that requires management with higher antibiotics based on culture and sensitivity tests.

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The urachus revisited: multimodal imaging of benign & malignant urachal pathology

British Journal of Radiology ◽

10.1259/bjr.20190118 ◽

2020 ◽

Vol 93 (1110) ◽

pp. 20190118

Author(s):

Jeeban Paul Das ◽

Hebert Alberto Vargas ◽

Aoife Lee ◽

Barry Hutchinson ◽

Eabhann O'Connor ◽

...

Keyword(s):

Urachal Cyst ◽

Imaging Features ◽

Foetal Development ◽

Urachal Remnant ◽

Bladder Dome ◽

Positron Emission ◽

Patent Urachus ◽

Urinary Tract Symptoms ◽

Urachal Sinus ◽

Ct And Mri

The urachus is a fibrous tube extending from the umbilicus to the anterosuperior bladder dome that usually obliterates at week 12 of gestation, becoming the median umbilical ligament. Urachal pathology occurs when there is incomplete obliteration of this channel during foetal development, resulting in the formation of a urachal cyst, patent urachus, urachal sinus or urachal diverticulum. Patients with persistent urachal remnants may be asymptomatic or present with lower abdominal or urinary tract symptoms and can develop complications. The purpose of this review is to describe imaging features of urachal remnant pathology and potential benign and malignant complications on ultrasound, CT, positron emission tomography CT and MRI.

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Acute abdomen due to an infected urachal cyst in a 5-year-old female: case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz156 ◽

2019 ◽

Vol 2019 (5) ◽

Cited By ~ 2

Author(s):

Aghyad Kudra Danial ◽

Ahmad Sankari Tarabishi ◽

Ahmad Aldakhil ◽

Ayham Alzahran ◽

Omar Najjar ◽

...

Keyword(s):

Acute Abdomen ◽

Clinical Presentation ◽

Exploratory Laparotomy ◽

Urachal Cyst ◽

Complete Excision ◽

Development Stages ◽

Patent Urachus ◽

Female Case ◽

Urachal Sinus ◽

Umbilical Ligament

Abstract The urachus is an embryonic tube that connects the upper portion of the bladder to the umbilicus, and obliterates normally during embryonic development stages forming the median umbilical ligament. Incomplete obliteration of this tube results in many anomalies such as congenital patent urachus, umbilical urachal sinus, vesicourachal diverticulum and urachal cyst. We report in this case a 5-year-old female presented to the Emergency, complaining of generalized abdominal pain, fever, vomiting, and constipation with no umbilical discharge. The clinical presentation accompanied by radiology investigations suggested a case of acute abdomen. We performed an exploratory laparotomy and found a mass above the bladder connected to the umbilicus; we excised the mass and sent a specimen to pathology that confirmed Urachal cyst. Urachal cyst is usually asymptomatic unless it is complicated; depending on our case, we recommend surgical management by complete excision for complicated urachal cyst.

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Surgical strategy of urachal remnants in children

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz222 ◽

2019 ◽

Vol 2019 (7) ◽

Cited By ~ 2

Author(s):

Yukihiro Tatekawa

Keyword(s):

Urinary Bladder ◽

Urachal Cyst ◽

Pathologic Examination ◽

Complete Excision ◽

Postoperative Course ◽

Pfannenstiel Incision ◽

Urachal Remnant ◽

Patent Urachus ◽

Urachal Sinus ◽

Open Excision

Abstract A urachus is a vestigial tubular structure that connects the urinary bladder to the allantois during early embryonic development. Urachal remnants are classified as patent urachus, urachal sinus, urachal cyst, and urachal diverticulum. Ten patients with urachal remnants underwent surgery at our institution between 2015 and 2019. Six patients had a urachal sinus, and four had a urachal diverticulum. Two patients with urachal sinus underwent excision of the urachal remnant, from the umbilicus to the urinary bladder, using an umbilical approach. The other four patients with urachal sinus underwent laparoscopic surgery with excision of the urachal remnant, from the umbilicus to the urinary bladder. All patients with urachal diverticulum underwent open excision of the diverticulum through a Pfannenstiel incision. Pathologic examination of all urachal remnants showed no evidence of neoplasm and complete excision. All patients had an uneventful postoperative course and are doing well.

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Urachal Cyst Causing Small Bowel Obstruction in an Adult with a Virgin Abdomen

Case Reports in Surgery ◽

10.1155/2016/3247087 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Michael P. O’Leary ◽

Zane W. Ashman ◽

David S. Plurad ◽

Dennis Y. Kim

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Acute Care Surgery ◽

Urachal Cyst ◽

Prostate Hyperplasia ◽

Lower Quadrant ◽

Patent Urachus ◽

History Of ◽

Care Surgery

Introduction. A patent urachus is a rare congenital or acquired pathology, which can lead to complications later in life. We describe a case of urachal cystitis as the etiology of small bowel obstruction in an adult without prior intra-abdominal surgery.Case Report. A 64-year-old male presented to the acute care surgery team with a 5-day history of right lower quadrant abdominal pain, distention, nausea, and vomiting. He had a two-month history of urinary retention and his past medical history was significant for benign prostate hyperplasia. On exam, he had evidence of small bowel obstruction. Computed tomography revealed high-grade small bowel obstruction secondary to presumed ruptured appendicitis. In the operating room, an infected urachal cyst was identified with adhesions to the proximal ileum. After lysis of adhesions and resection of the cyst, the patient was subsequently discharged without further issues.Conclusion. Although rare, urachal pathology should be considered in the differential diagnosis when evaluating a patient with small bowel obstruction without prior intraabdominal surgery, hernia, or malignancy.

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Ultrasound findings of urachal anomalies. A series of interesting cases

Medical Ultrasonography ◽

10.11152/mu-1878 ◽

2019 ◽

Vol 21 (3) ◽

pp. 294 ◽

Cited By ~ 2

Author(s):

Xianghong Luo ◽

Jun Lin ◽

Lianfang Du ◽

Rong Wu ◽

Zhaojun Li

Keyword(s):

Differential Diagnosis ◽

High Frequency ◽

Urachal Cyst ◽

Diagnostic Ability ◽

Patent Urachus ◽

Ultrasound Findings ◽

Urachal Sinus ◽

Us Findings ◽

Distinct Features ◽

High Frequency Probe

Aims: This study’s aim is to present the specific ultrasonography (US) findings of a series of urachus anomalies. Material and methods: Seven patients with suspected urachal anomalies underwent US scanning initially prior to the surgery and the features of images were reviewed respectively. The clinical data and pathologic results were collected also. Results: US successfully diagnosed urachal anomalies in 5 patients (5/7, 71.4%) and failed to diagnose in 2 patients (2/7, 28.6%). Patent urachus showed a tubule between the umbilicus and bladder; urachal sinus was a blind focal dilatation at the umbilical end, while vesicourachal diverticulum was an outpouching at the vesical end and urachal cyst was identified as an anechoic structure along the urachus. Non-enhancement in the base and centre was the distinct features of urachus carcinoma by contrastenhanced ultrasonography (CEUS). Using a high frequency probe and CEUS the diagnostic ability of US may be improved. Conclusion: US showed good diagnostic ability in urachal anomalies and combined with CEUS could improve the differential diagnosis.

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Umbilical Cord Hernia Associated with a Patent Urachus: A Case Report

10.36502/2020/asjpch.6151 ◽

2020 ◽

Vol 2 (1) ◽

pp. 13-18

Author(s):

María SC ◽

Pedro-José LE ◽

Marina PS ◽

Carolina AM

Keyword(s):

Abdominal Wall ◽

Umbilical Cord ◽

Muscle Development ◽

Abdominal Wall Defect ◽

Urachal Cyst ◽

Abdominal Wall Defects ◽

Associated Anomalies ◽

Wall Defect ◽

Patent Urachus ◽

Umbilical Cord Hernia

An umbilical cord hernia (UCH) is a form of abdominal wall defect, affecting 6 out of every 10,000 newborns. The persistence of urachus is an embryonic remnant that connects the bladder to the abdominal wall at the level of the umbilicus, being yet more uncommon. We reviewed the literature, searching in PubMed, under the terms “Hernia of umbilical cord”, “Congenital hernia of cord” and “Persistent Urachus”. Only a few similar cases of both pathologies associated described were found. Our main objective is to highlight the distinct clinical features, embryogenesis, prognosis and associated anomalies of two infrequent embryopathies. And to describe a infrequent case of both abnormalities presenting simultaneously. UCH are often misdiagnosed with other abdominal wall deffects, such as omphalocele, umbilical hernias, gastroschisis and umbilical cord cysts. The normal cord insertion, adequate muscle development of the abdominal wall and a wall defect less than 5cm is what differentiates it from an omphalocele. UCH has a low morbidity overall, as it is not associated with other anomalies. The most frequently observed urachal malformations are the persistence of a urachus and urachal cyst. The prenatal diagnosis of patent urachus is made by ultrasound or magnetic resonance, being easily mistaken with abdominal wall defects, confirming the diagnosis with an ultrasound at birth. The persistence of urachus may resolve spontaneously, if not, surgical resolution is recommended. Similar to a UCH, a patent urachus shows little association with other malformations. It is important to know the clinical presentation and the diagnostic perinatal methods employed for appropriate management and favorable results for both pathologies. This relies on knowing when to suspect possible associated anomalies and when complementary studies might be needed. It is also important to be aware that there is the possibility of a UCH and a patent urachus existing simultaneously.

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Mesenteric Cysts: A Retrospective Review. Its Not All That Simple

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.257 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S117-S118

Author(s):

M Bourgeau ◽

V Avadhani

Keyword(s):

Cyst Wall ◽

Imaging Techniques ◽

Case Reports ◽

Lymphatic Vessels ◽

Mucinous Cystadenoma ◽

Final Diagnosis ◽

Cystic Mass ◽

Pathological Examination ◽

Urachal Cyst ◽

Mesenteric Cysts

Abstract Introduction/Objective Mesenteric cysts are rare intra-abdominal lesions in adults. However, with the advanced imaging techniques and laparoscopic techniques, they are more often being identified and resected when clinically significant. There is a lack of detailed information in histopathology (except as case reports) since mesentery is generally neglected in our organ-based textbooks. The aim of our study is to highlight the importance of identifying and classifying mesenteric cystic lesions; they are not all that simple. Methods We performed a retrospective search on all mesenteric cysts submitted as excisions in our electronic database from 2013-2019. We classified them as per the de Perrot (PMID: 11053936) classification with modification. Results Our search showed: A. Lymphatic origin-11 (lymphangioma-10, Lymphangioma hamartomatous-1, associated with LAM-0), B. Mesothelial origin-68 (Benign mesothelial cysts-57, multilocular mesothelial cyst-11), C. Enteric origin- 3, D. Urogenital origin (Urachal cyst, mullerian inclusion cyst)-9, E. Mature cystic teratom-2, F. Pseudocyst-12, G. Epithelial cyst (not urogenital)- 11 (a/w LAMN-3, MCN-4, Mucinous cystadenoma-4), H. Associated with carcinoma-2. Case illustration: A 61-year-old male presented with worsening dysphagia, emesis and hiccups. A CT scan showed a 21.2 cm cystic mass with at least one septation (Fig 1). The cyst was resected. On gross pathological examination, the cyst measured 18 cm in greatest dimension with a thick, rough, tan-brown capsule. Microscopic examination showed a fibrous capsule, and cyst wall composed of numerous lymphatic vessels (CD31 positive) and prominent smooth muscle proliferation (Desmin positive). Scattered lymphoid aggregates were also present throughout the cyst wall. No definite epithelial lining was identified and was suspected to have been denuded. HMB-45 immunostain was negative, ruling out association with LAM. The final diagnosis of a Lymphangiomyoma, hamartomatous was rendered. Conclusion Though most of the mesenteric cysts are benign, some of them are significantly important such as Lymphangiomyoma (esp secondary to LAM), MCN, those associated with LAMN etc. and identifying and differentiating from their mimics has distinct clinical implications.

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An Unusual Case of Meckel Diverticulitis Misdiagnosed as an Infected Urachal Cyst

Medicina ◽

10.3390/medicina57050495 ◽

2021 ◽

Vol 57 (5) ◽

pp. 495

Author(s):

Ioana Anca Stefanopol ◽

Magdalena Miulescu ◽

Liliana Baroiu ◽

Aurelian-Dumitrache Anghele ◽

Dumitru Marius Danila ◽

...

Keyword(s):

Meckel’S Diverticulum ◽

Surgical Excision ◽

Cyst Formation ◽

Meckel's Diverticulum ◽

Urachal Cyst ◽

Macroscopic Appearance ◽

Surgical Interventions ◽

Bladder Dome ◽

Low Sensitivity ◽

Tract Infections

Introduction: Meckel’s diverticulum (MD), a remnant of the omphaloenteric duct, is among the most frequent intestinal malformations. Another embryonic vestige is the urachus, which obliterates, becoming the median umbilical ligament; the failure of this process can lead to a urachal cyst formation. We present a case of Meckel diverticulitis misdiagnosed as an infected urachal cyst. Presentation of case: A 16-year-old girl presented with hypogastric pain, fever and vomiting. She had undergone an appendectomy 6 years prior and no digestive malformation had been documented. In the last 2 years, she had 3 events of urinary tract infections with Escherichia coli, and anabdominal ultrasound discovered a 28/21 mm hypoechogenic preperitoneal round tumor, anterosuperior to the bladder. We established the diagnosis of an infected urachal cyst, confirmed later by magnetic resonance imaging. Intraoperative, we found MD with necrotic diverticulitis attached to the bladder dome. Discussions: Meckel’s diverticulum and urachal cyst (UC) are embryonic remnants. Both conditions are usually asymptomatic, being incidentally discovered during imaging or surgery performed for other abdominal pathology. Imaging diagnosis is accurate for UC, but for MD they are low sensitivity and specificity. For UC treatment, there is a tendency to follow an algorithm related to age and symptoms, but there is no general consensus on whether to perform a routine resection of incidentally discovered MD. Conclusion: Preoperatory diagnosis of MD represents a challenge. We want to emphasize the necessity of a thorough inspection of the small bowel during all abdominal surgical interventions and MD surgical excision regardless of its macroscopic appearance. These two actions seem to be the best prophylaxis measures for MD complications and consequently to avoid emergency surgery, in which case more extensive surgical procedures on an unstable patient may be needed.

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Dysuria, Rebound Tenderness, and a Palpable Mass—A Ticking Time Bomb

Military Medicine ◽

10.1093/milmed/usab180 ◽

2021 ◽

Author(s):

Tyler Miklovic ◽

Philip Davis

Keyword(s):

Emergency Department ◽

Case Reports ◽

Pubic Symphysis ◽

Subsequent Treatment ◽

Urachal Cyst ◽

Significant Morbidity ◽

Palpable Mass ◽

Rebound Tenderness ◽

Patient Reported ◽

Middle Aged Adult

ABSTRACT A 37-year-old male presented to the emergency department with the complaint of periumbilical abdominal pain, radiating to just above pubic symphysis. The patient reported that the pain was worse with urination and associated with chills and nausea. This case reports discusses the Emergency Department (ED) course and subsequent treatment of a patient found to have an infected urachal cyst, a previously asymptomatic embryological anomaly in an otherwise healthy middle-aged adult male. This is a crucial diagnosis to make in order to avoid the potential for significant morbidity and/or mortality, given the unlikely symptomatic source.

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