Infected urachal cyst in an adult: a case report and review of the literature

Cases Journal - Tập 2 - Trang 1-3 - 2009
Kingsley C Ekwueme1, Nigel J Parr1
1Department of Urology, Wirral University Teaching Hospital, Wirral, UK

Tóm tắt

Urachal cyst is one of a spectrum of urachal abnormalities most commonly found in children. They are very rarely seen in adults because the urachus is normally obliterated in early infancy. We describe a case of a 32 year old male Caucasian who presented with a tender, midline, infraumbilical mass and purulent umbilical discharge. Diagnosis of an infected urachal cyst was confirmed on magnetic resonance scan. He was treated initially with broad spectrum antibiotics in order to allow sepsis to resolve prior to surgical excision of the cyst and fibrous tract. Cystoscopy was performed intraoperatively to exclude sinus communication with the bladder. Histology of the excised specimen showed chronic inflammation with no evidence of malignancy. Postoperative recovery was uneventful. Urachal abnormalities are rare in adults. Clinical presentation is non-specific; therefore, a high index of suspicion is required in order to make the diagnosis. When diagnosed, surgical excision is advised because of the risk of malignant transformation.

Tài liệu tham khảo

Hammond G, Yglesias L, Davis JE: The urachus, its anatomy and associated fascia. Anat Rec. 1941, 80: 271-274. 10.1002/ar.1090800302. Risher WH, Sardi A, Bolton J: Urachal abnormalities in adults: the Ochsner experience. South Med J. 1990, 83: 1036-1039. Begg RC: The Urachus: its Anatomy, Histology and Development. J Anat. 1930, 64: 170-183. Ashley RA, Inman BA, Routh JC, Rohlinger AL, Husmann DA, Kramer SA: Urachal anomalies: a longitudinal study of urachal remnants in children and adults. J Urol. 2007, 178: 1615-1618. 10.1016/j.juro.2007.03.194. Yoo KH, Lee SJ, Chang SG: Treatment of infected urachal cysts. Yonsei Med J. 2006, 47: 423-427. 10.3349/ymj.2006.47.3.423. Flanagan DA, Mellinger JD: Urachal-sigmoid fistula in an adult male. Am Surg. 1998, 64: 762-763. Maruschke M, Kreutzer HJ, Seiter H: Bladder rupture caused by spontaneous perforation of an infected urachal cyst. Urologe A. 2003, 42: 834-839. 10.1007/s00120-002-0290-3. Ohgaki M, Higuchi A, Chou H, Takashina K, Kawakami S, Fujita Y, Hagiwara A, Yamagishi H: Acute peritonitis caused by intraperitoneal rupture of an infected urachal cyst: report of a case. Surg Today. 2003, 33: 75-77. 10.1007/s005950300016. Mazzucchelli R, Scarpelli M, Montironi R: Mucinous adenocarcinoma with superficial stromal invasion and villous adenoma of urachal remnants: a case report. J Clin Pathol. 2003, 56: 465-467. 10.1136/jcp.56.6.465. Newman BM, Karp MP, Jewett TC, Cooney DR: Advances in the management of infected urachal cysts. J Pediatr Surg. 1986, 21: 1051-1054. 10.1016/0022-3468(86)90006-0.