ABSTRACT
Background: Infected urachal cysts are rare clinical manifestations in older adults. A high level of suspicion is essential for the diagnosis of this condition. Objective: To describe the clinical features of infected urachal cysts, clues to the diagnosis, and the method of treatment. Patients: We treated a 68-year-old woman who presented with a midline suprapubic mass with pain and fever. Result: There were no post-operative complications. Pathological findings were consistent with an infected urachal cyst with a chronic abscess extending to the dome of the urinary bladder, without malignancy. There were severe acute and chronic abscesses in the omentum. Histological findings demonstrated vascularized granulation tissue with inflammatory cell infiltration beneath denuded urothelial lining. Conclusion: Complete excision of urachal cysts with a bladder cuff is recommended to avoid an uncommon development of carcinoma in unresected tissue, which has poor prognosis due to its late presentation and local invasion.
ABSTRACT
PURPOSE: Urachal anomalies are rare, but often give rise to a number of problems, such as infection, rupture, sepsis and malignant change. The abdominal manifestation of urachal remnants often prompts referral to general or urologic surgeons. Herein, our clinical experiences were analyzed and guide lines for the preoperative diagnosis and proper management of complicated urachal anomalies suggested. METHODS: Twelve cases of urachal cyst, who visited the surgery department of Pochon CHA university hospital between April 1, 1995 and December 10, 2002, were studied. Clinical data, including clinical manifestations, diagnostic modalities and treatment methods were reviewed. RESULTS: Of the twelve cases reviewed, nine were males and three were females with a mean age of 33.6 years. The most common clinical manifestation was abdominal pain (58%), followed by a palpable mass (25%). The accuracies of the diagnostic modalities were 60 and 37% for abdominopelvic computed tomography and abdominal ultrasonography, respectively. The preoperative diagnosis rate was 50%, with one case not even diagnosed during surgery. CONCLUSION: Persistent urachal remnants can present at any age, with a variety of clinical manifestations. Abdominal computed tomography is a reliable diagnostic tool, and additional diagnostic studies are not generally warranted. The early surgical treatment seems to be the best solution prior to the onset of complications that would expose patients to difficult surgical operations and protract hospitalization.