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. 2018:49:87-90.
doi: 10.1016/j.ijscr.2018.06.018. Epub 2018 Jun 27.

Laparoscopic treatment of an infected urachalcyst and diverticulum in a young adult: Presentation of a case and review of the literature

Stefano Passoni  1 , Adriano Guerra  2 , Michele Marengo  2
Affiliations

Laparoscopic treatment of an infected urachalcyst and diverticulum in a young adult: Presentation of a case and review of the literature

Stefano Passoni et al. Int J Surg Case Rep. 2018.

Abstract

Introduction: A urachal remnant is a rare anomaly in adults, with a heterogeneous presentation. We report a case of an infected urachal cyst associated with a urachal diverticulum.

Presentation of case: We report the case of a 16-year-old male who presented to our hospital with lower abdominal pain without any other signs of general infection. A physical examination revealed umbilical erythema with associated tenderness. All laboratory tests were normal. An ultrasound scan revealed an urachal cyst near the umbilicus and a second cyst near the bladder dome. We decided on a staged treatment with antibiotic administration followed by surgical excision of the urachus during laparoscopy. The patient was discharged on day 10 without complications. Pathology revealed chronic inflammatory tissue without signs of malignancy.

Discussion: Urachus is a fibrous remnant of the allantois that progressively obliterates after birth, forming the median umbilical ligament. Incomplete regression of the urachal lumen results in several anomalies. These anomalies require treatment when discovered because of an increased risk of infection and neoplastic differentiation. A urachal cyst is the most common type of anomaly, and infection is the usual mode of presentation. Surgical intervention with complete excision of the urachus is the treatment of choice. A staged approach with antibiotic administration followed by surgery is recommended if signs of infection are present.

Conclusion: Urachal anomalies in adulthood are rare, with a nonspecific presentation. However, identifying a urachal anomaly is important because of the increased risk for infection and neoplastic differentiation. The laparoscopic approach is safe and patients recover rapidly.

Keywords: Infected urachal cyst; Laparoscopy; Urachal diverticulum; Urachus.

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Figures

Fig. 1
Fig. 1
Abdominal US showing the urachal cyst near the umbilicus.
Fig. 2
Fig. 2
Abdominal US showing a second cyst near the bladder dome, without apparent communication with the bladder.
Fig. 3
Fig. 3
Laparoscopic image of the urachal diverticulum.
Fig. 4
Fig. 4
Bladder defect after resection of th urachal diverticulum.
See this image and copyright information in PMC

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