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. 2019:57:130-133.
doi: 10.1016/j.ijscr.2019.03.041. Epub 2019 Mar 30.

Surgical management for an infected urachal cyst in an adult: Case report and literature review

Adel Elkbuli  1 , Kyle Kinslow  2 , John D Ehrhardt Jr  2 , Shaikh Hai  2 , Mark McKenney  3 , Dessy Boneva  3
Affiliations

Surgical management for an infected urachal cyst in an adult: Case report and literature review

Adel Elkbuli et al. Int J Surg Case Rep. 2019.

Abstract

Introduction: Incomplete urachal obliteration during fetal development gives rise to distinct malformations of the median umbilical ligament. Most anomalies are asymptomatic and resolve during early infancy, but some go unrecognized until adulthood. These rare cases can present with acute abdominal symptomatology secondary to infected urachal remnants.

Presentation of case: A 20-year-old man presented with periumbilical pain. Physical exam showed a warm, erythematous infra-umbilical mass that was tender to palpation. CT revealed an infected urachal cyst. The patient underwent urachal abscess incision and drainage with cyst excision. The patient returned home on postoperative day two. Two-week outpatient follow-up confirmed an uncomplicated recovery.

Discussion: Surgical excision of urachal anomalies in adults is curative and preventive against recurrent infection and malignancy, but preoperative management is currently unstandardized. Current literature recommends a two-stage approach characterized by preoperative antibiotics and cyst incision and drainage followed later by complete surgical excision. Our patient underwent a single therapeutic approach with preoperative antibiotics and definitive operative excision. Our patient had a comparable outcome with no complications and a short hospitalization.

Conclusion: Preoperative antibiotics with excision of urachal remnants was effective in our case. Staged approaches are appropriate in complicated cases as a means to reduce post-operative infection rates and hospital stays. Urachal remnant excision is recommended in adults to prevent future malignancy.

Keywords: Cysto-urachal malignancy; Two-stage approach; Urachal cyst infection; Urachal remnants.

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Figures

Fig. 1
Fig. 1
Axial CT abdomen showing urachal remnant extending through the ventral abdominal wall with associated inflammatory infiltrate and central lucency suggestive of abscess.
Fig. 2
Fig. 2
A. Intraoperative urachal cyst excision via median mini-laparotomy. B. Intraoperative expression of sebaceous material from infected urachal cyst.
Fig. 3
Fig. 3
Excised urachal cyst specimen.
See this image and copyright information in PMC

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