A case of laparoscopic excision of patent urachus

Patent urachus is an uncommon congenital anomaly caused by persistence of embryologic communication between bladder and umbilicus. The traditional surgical approach has been open for years but laparoscopic approach has become an effective and minimal invasive technique to treat urachal remnants. A 11 years old child presenting as umbilical discharge was diagnosed with patent urachus and treated by laparoscopic excision. There was no intra or postoperative complications. Patient was discharged on post-operative day 1. The urachus connects the fetal allantois at umbilicus to the dome of bladder. Normally it obliterates and gives rise to median umbilical ligament. Urachus is extraperitoneal and easily viewed during laparoscopic visualization of pelvis. Urachal remnants represent a rare congenital anomaly due to failure in obliteration process. Complete excision is indicated both in case of persistent symptomatic remnants and also when asymptomatic for the associated risk of malignant degeneration. The traditional approach has been open surgery. However, it is associated with increased morbidity and longer convalescence. Reporting our experience, we describe the technique step by step of laparoscopic patent urachus excision as minimally invasive diagnostic and surgical approach in comparison to open surgical approach, with better post-operative analgesia, rapid healing and cosmetic results.

A rare case of spontaneous nephrocutaneous fistula

Acute and chronic pyelonephritis are known afflictions to the kidney in diabetics and in patients of abnormal urinary anatomy. And its presentation as a spontaneous sinus opening on the anterior abdominal wall is a rare phenomenon. We present one such rare case of a 71-year-old male with pus discharge from the anterior abdominal wall for 7 months. On investigating, it was found to be a nephrocutaneous fistula arising from the left non-functional kidney. This was dealt with left nephrectomy along with excision of the sinus tract. Though a very rare condition, a possibility of nephrocutaneous fistula must be kept when dealing with discharging sinus in lumbar region.