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

2019 ◽  
Vol 2019 (5) ◽  
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.

scholarly journals Surgical strategy of urachal remnants in children

2019 ◽  
Vol 2019 (7) ◽  
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.

scholarly journals Experience of management of abdominal cysts

2020 ◽  
Vol 7 (10) ◽  
pp. 3404
Author(s):  
Dhananjay Vaze ◽  
Pranav Jhadav ◽  
Rajesh M. ◽  
Adarsh Hegde ◽  
Sanjay Raut ◽  
...  
Keyword(s):  
Medical Records ◽  
Clinical Presentation ◽  
Laparoscopic Approach ◽  
Exploratory Laparotomy ◽  
Urachal Cyst ◽  
Duct Cyst ◽  
Clinical Presentations ◽  
Abdominal Masses ◽  
The Common ◽  
Cystic Masses

Benign intra-abdominal cystic masses in children are rare and they have diverse etiopathogenesis, clinical presentation. The present study highlights the experience in the management of benign intra-abdominal cysts pertaining to the diverse etiologies associated with these lesions. The medical records of our hospital between November 2016 to November 2019 were retrospectively reviewed. Patients with cystic abdominal masses were studied with respect to less different clinical presentations, localization of masses, diagnostic tests, surgical aapproaches, histopathological examinations and outcome. Out of the 55 cases, most common lesion was a choledochal cyst. Miscellaneous diagnosis includes an omental cyst, urachal cyst and a pedunculated bile duct cyst. All the cystic lesions of the abdomen need to be considered as close differentials in clinical practice due to the common presentations and similar symptoms produced by these lesions. All the lesions were managed by exploratory laparotomy except two ovarian cysts which were managed with laparoscopic approach.

scholarly journals LINFAGIOMA QUÍSTICO DE EPIPLÓN COMO CAUSA DE ABDOMEN AGUDO PEDIÁTRICO. ACTUALIZACIÓN DEL TRATAMIENTO: REPORTE DE CASO.

2021 ◽  
Vol 32 (1) ◽  
pp. s5-s6
Author(s):  
Galo Fabián García ◽  
Gerardo Mauricio Siavichay ◽  
Andrea Priscila Guillermo ◽  
Luis Fernando García ◽  
Danny Renán García
Keyword(s):  
Acute Abdomen ◽  
Peritoneal Fluid ◽  
Exploratory Laparotomy ◽  
Greater Omentum ◽  
Cystic Tumor ◽  
Polymorphonuclear Cells ◽  
Complete Excision ◽  
Abdominal Masses ◽  
One Year

Introduction Mesenteric lymphagioma is a rare, benign, congenital cystic tumor of the lymphatic vessels, which occurs in 2-5% of cases at the abdominal level (75% cervical, 20% axillary), which occurs more frequently during the childhood. It occurs with an incidence of 1: 250,000 during childhood (60% cases before one year of age), the ratio of women to men is 2: 1. They are located mainly in the subperitoneal space, in the mesentery (59% - 68%), omentum (20% - 27%) and retroperitoneum (12% - 14%). This should be suspected as a differential diagnosis of acute abdomen and pediatric abdominal masses. Its complete excision with negative microscopic margins is the treatment of choice, either by conventional means by exploratory laparotomy or by other less invasive techniques such as laparoscopy. Case description A 6-year-old boy presented with abdominal pain and peritonism. Physical exam: positive rebound sign. Paraclinical: leukocytosis, neutrophilia. Ultrasound shows abundant free fluid in the abdomen and pelvis. Patient undergoes an exploratory laparotomy, finding a multicystic mass dependent on the greater omentum, a sample of peritoneal fluid is taken for cytochemical, bacteriological, culture and histopathology. Complete excision of the cyst plus partial omentectomy and incidental appendectomy is performed. Patient with favorable evolution tolerates diet at 24 hours with progression from liquid to soft, undergoes antibiotic treatment for 48 days based on cefazolin (suspended due to negative culture at 48 hours and negative BARR), with hospital discharge on the fourth day. Result of fibrin-filled peritoneal fluid, transudate and negative histopathology for malignancy. Histopathology report: Macroscopic: irregular tissue fragment measuring 10 x 6 cm, greyish-yellow, cystic areas measuring 1.5 and 4 cm; When cut, it drains mucinous material, the rest of the irregular yellowish areas. Microscopic: fibrofatty tissue with congestive vessels and mixed inflammatory infiltrate (lymphocytes and polymorphonuclear cells), compatible with cystic lymphagioma (Fig. 3). Immunohistochemistry positive for marker D 2-40. Patient with follow-up at 7 days; In months 1, 3, 6 and year with favorable evolution, a control ultrasound was performed at the sixth month and at one year without evidence of recurrence. Conclusion: Mesenteric cystic lymphagioma can present with symptoms of acute abdomen. Complete resection is the treatment of choice, minimally invasive procedures are currently performed with favorable results in children, ultrasound is sufficient for long-term follow-up.

scholarly journals Urachal Cyst in a Bitch

2019 ◽  
Vol 47 ◽  
Author(s):  
Fernanda Campos Hertel ◽  
Aline Silvestrini Da Silva ◽  
Gabriela Castro Alves Evangelista ◽  
Amanda Pereira Dos Anjos ◽  
Andreia Correia Araújo ◽  
...  
Keyword(s):  
Congenital Anomalies ◽  
Clinical Presentation ◽  
Incidental Finding ◽  
Imaging Techniques ◽  
Exploratory Laparotomy ◽  
The Other ◽  
Urachal Cyst ◽  
Tubular Structures ◽  
Cystic Structure ◽  
Caudal Portion

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 bitch Pit Bull, 3-year-old, 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 becomes a cystic structure since its epithelium is still intact, active and accumulating fluid, like the one analysed in this report. Most urachal cysts in humans remain asymptomatic, but when infected, they can cause focal or diffuse peritonitis and an acute abdomen. Although rare, urachal cysts can develop malignant transformation. The combination of nonspecific symptoms and the infrequent occurrence of this anomaly make its diagnosis a difficult challenge. It is commonly an incidental finding like the case reported here. Therefore, diagnostic imaging techniques, especially ultrasound, are essential for the diagnosis. To our knowledge, this is the first case report of a urachal cyst in a dog. This rare anomaly of the urachus was an incidental finding in the investigation of the reproductive problems of a female dog.

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

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.

scholarly journals Chronic umbilical abscess secondary to a patent urachus in a 30 years male: a case report

2021 ◽  
Vol 8 (9) ◽  
pp. 2845
Author(s):  
Akula Nynasindhu ◽  
Swetana Palavalasa
Keyword(s):  
Case Report ◽  
Urinary Bladder ◽  
Ct Scan ◽  
Regional Anaesthesia ◽  
Clinical Presentation ◽  
Adult Population ◽  
High Index ◽  
Patent Urachus ◽  
Urachal Sinus ◽  
High Index Of Suspicion

Urachus is epithelialized, fibromuscular remnant part connecting urinary bladder with umbilicus. Urachal anomalies present and progress differently in paediatric and adult population. They remain largely asymptomatic until infected. Clinical presentation may vary from simple discharge from umbilicus to intrabdominal abscess and peritonitis. We present a case of urachal sinus presenting as recurrent umbilical abscess. 30 years male presented with complaints of umbilical mass with pus discharge. He was evaluated clinically and radiologically. Ultrasound revealed a localized collection near umbilicus whereas CT scan revealed connection of that collection to a fibrous strand like structure approximately 10 cm extending from umbilicus to urinary bladder. An open exploration was done under regional anaesthesia and 20 ml of abscess drained with excision of tract by ligating near the bladder end. Local debridement was done near the umbilical area. Wound closed in layers. Post-op period was uneventful without any recurrence. urachal anamolies need a high index of suspicion in adults to intervene early and get better outcomes with less morbidity.

scholarly journals Ultrasound findings of urachal anomalies. A series of interesting cases

2019 ◽  
Vol 21 (3) ◽  
pp. 294 ◽  
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.

scholarly journals A Challenging Case of a Physeal Bar Endoscopic-Assisted Resection in a Short Stature Child: Case Report and Literature Review

2021 ◽  
pp. 115-120
Author(s):  
Melanie Ribau ◽  
Mário Baptista ◽  
Nuno Oliveira ◽  
Bruno Direito Santos ◽  
Pedro Varanda ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Short Stature ◽  
Clinical Presentation ◽  
Normal Growth ◽  
Limb Length Discrepancy ◽  
Complete Excision ◽  
Physeal Bar ◽  
Surgical Options ◽  
The Ideal

Partial physeal bars may develop after injury to the growth plate in children, eventually leading to disturbance of normal growth. Clinical presentation, age of the patient, and the anticipated growth will dictate the best treatment strategy. The ideal treatment for a partial physeal bar is complete excision to allow growth resumption by the remaining healthy physis. There are countless surgical options, some technically challenging, that must be weighted according to each case’s particularities. We reviewed the current literature on physeal bars while reporting the challenging case of a short stature child submitted to a femoral physeal bar endoscopic-assisted resection with successful growth resumption. This case dares surgeons to consider all options when treating limb length discrepancy, such as the endoscopic-assisted resection which might offer successful results.

A Rare Cause of Mechanical Intestinal Obstruction: A Neoplastic Intra-Abdominal Testis

2016 ◽  
Vol 101 (3-4) ◽  
pp. 167-170
Author(s):  
Fatih Ciftci ◽  
Suat Benek ◽  
Cem Kezer
Keyword(s):  
Intestinal Obstruction ◽  
Acute Abdomen ◽  
Undescended Testis ◽  
Abdominal Mass ◽  
Relevant Literature ◽  
Large Diameter ◽  
Exploratory Laparotomy ◽  
Clinical Findings ◽  
Surgical Units ◽  
Mechanical Intestinal Obstruction

The acute abdomen has many etiologies frequently encountered in emergency surgical units. Approximately 20% of surgical admissions for acute abdominal conditions are for intestinal obstruction. Clinicians often overlook rarer causes. A 43-year-old man presented to the emergency ward with the clinical findings of ileus. Computed tomography revealed a heterogeneous necrotic 168 × 100-mm mass between the sigmoid colon and urinary bladder. Physical examination revealed a palpable intra-abdominal mass that was removed via exploratory laparotomy. On histopathologic examination, the mass was identified as a seminoma. The literature contains few reports of seminoma as a cause of acute abdomen and ileus, mostly seen between the ages of 30 and 40 years. We report a patient with seminoma arising in an undescended testis that presented as a palpable painful lower abdominal mass and mechanical intestinal obstruction, despite the large diameter of the mass, as well as review relevant literature.

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