Urachal adenocarcinoma: incidental finding at the time of surgery for ruptured appendicitis

Abstract

Background: The urachus is a vestigial structure between the dome of the bladder and the umbilicus. Tumors may develop from the remnants, most of which are well-differentiated, mucinous adenocarcinomas. Urachal adenocarcinoma is an exceedingly rare type of tumor.

Methods: We present a case of a 51-year-old female presenting to our institution with complaints of abdominal pain for 36 hours. The patient was taken to the operating room for an acute appendicitis. Laparoscopy was performed, and gross purulence and appendiceal perforation were noted as well as a mass on the anterior abdominal wall. Based on the location of the mass, we converted to an open midline laparotomy to treat both the perforated appendicitis and to remove the mass.

Results: Pathology confirmed the diagnosis of perforated appendicitis and a mucinous-producing urachal adenocarcinoma.

Discussion: Data support both open and laparoscopic approaches for appendicitis. This case, although rare, highlights the importance of laparoscopy in a complete and thorough examination of the abdominal cavity. A standard right lower quadrant incision for an open technique would likely have resulted in omission of this lesion, and the patient would have presented at a more typical late stage of her cancer development with significantly more morbidity.

Figure 1.

Computed tomographic scan showing pericecal fluid consistent with acute appendicitis.

Figure 2.

Purulent drainage in pelvis.

Figure 3.

Gross appearance of anterior abdominal wall mass with adherent appendix.

Figure 4.

Perforated appendix.

Figure 5.

Anterior wall abdominal mass.

Figure 6.

High-power view of specimen revealing pools of mucin.