Persistencia de uraco en paciente joven. Reporte de caso / Persistence of urachus in a young patient. Case report

Introducción. Durante el desarrollo embrionario normal, se espera que el denominado uraco o ligamento umbilical mediano se oblitere a las 32 semanas de gestación. Ante una obliteración incompleta surgen las diferentes anomalías, siendo las más frecuentes el quiste y la fístula urinaria umbilical. El objetivo de este artículo fue presentar el caso de una paciente joven, sin comorbilidades, con quiste de uraco. Caso clínico. Mujer indígena de 19 años que consultó por dolor leve en hipogastrio, asociado a síntomas urinarios y distensión abdominal. Se sospechó en primera instancia cólico renal, pero ante hallazgos ecográficos de masa infraumbilical y reactantes de fase aguda elevados, la impresión diagnóstica cambió a sepsis secundaria a absceso intraabdominal. Posterior a tomografía y cistoscopía con calibración uretral se identificó pequeño divertículo en cúpula vesical, que sugirió el diagnóstico de uraco persistente, por lo que la paciente fue llevada a intervención quirúrgica para su resección, con evolución favorable. Discusión. El quiste de uraco es una anormalidad infrecuente, en su mayoría asintomática y generalmente de hallazgo incidental en la población anciana, por lo que se requiere de imágenes y manejo multidisciplinar para su correcto diagnóstico y abordaje. Conclusión. Son pocos los casos de uraco persistente reportados, y mucho menos en el sexo femenino. Dada la posibilidad de complicaciones tardías es importante el seguimiento para su manejo. Este caso se ha controlado de manera ambulatoria por 2 años

Introduction. During normal embryonic development, it is expected that the so-called urachus or median umbilical ligament will be obliterated at 32 weeks of gestation. In the face of incomplete obliteration, the different anomalies of the urachus arise. The most frequent anomaly of the urachus is the cyst followed by the umbilical urinary fistula. The objective of this article was to present the case of a young patient without comorbidities with urachal cyst. Clinical case. A 19-year-old indigenous woman consulted for mild hypogastric pain associated with urinary symptoms and abdominal distension. Renal colic was suspected at first, but due to ultrasound findings of an infraumbilical mass and high acute phase reactants, the diagnostic impression changed to sepsis secondary to an intra-abdominal abscess. After tomography and cystoscopy with urethral calibration, a small diverticulum was identified in the bladder dome, suggesting a diagnosis of persistent urachus, for which the patient was taken to surgery for its resection, with favorable evolution. Discussion. The urachal cyst is a rare abnormality, mostly asymptomatic and usually incidental finding in the elderly population. Imaging and multidisciplinary management are required for its correct diagnosis and approach. Conclusion. There are few reported cases of persistent urachus and much less in females. Given the possibility of late complications, follow-up is important for its management, in this case we have carried out control for 2 years

Absceso del uraco y obstrucción intestinal en paciente con obesidad mórbida: reporte de caso / Urachal abscess and intestinal obstruction in a morbidly obese patient: A case report

Las anomalías del uraco representan un bajo porcentaje de las patologías abdominales, no obstante, forman parte del diagnóstico diferencial del abdomen agudo por las complicaciones que puede tener. Aunque son de difícil diagnóstico debido a los síntomas inespecíficos, las imágenes diagnósticas son de gran utilidad para su identificación y caracterización. En pacientes con obesidad mórbida, la presentación del cuadro aumenta el riesgo de morbimortalidad. Por ende, en estos pacientes es necesario un control postoperatorio estricto para evaluar complicaciones secundarias a la resección del uraco. Dado los casos limitados en la literatura, se requieren estudios clínicos adicionales, para brindar un seguimiento adecuado, en aras de identificar complicaciones y el tratamiento precoz de estas

Urachal abnormalities represent a low percentage of abdominal pathologies; however, they are part of the differential diagnosis of acute abdomen due to the complications it may have. Although they are difficult to diagnose due to nonspecific symptoms, diagnostic images are especially useful for their identification and characterization. In patients with morbid obesity, the presentation of the picture increases the risk of morbidity and mortality. Therefore, in these patients, strict postoperative control is necessary to evaluate complications secondary to urachal resection. Given the limited cases in the literature, additional clinical studies are required to provide adequate diagnosis and follow-up in order to identify complications and their early treatment

Resección laparoscópica de adenocarcinoma de uraco / Laparoscopic resection of uraco adenocarcinoma

El adenocarcinoma de uraco es una enfermedad neoplásica rara, con una incidencia de 1 por 5 millones de habitantes. Clínicamente se manifiesta con hematuria (73%), dolor abdominal (14%), disuria (13%), mucosuria (10%), síntomas irritativos (40%), masa palpable en la parte baja del abdomen (17%), bacteriuria (8%), flujo mucoso umbilical (2%). Presentamos el caso de paciente de 45 años, con diagnóstico de adenocarcinoma de uraco, que recibió múltiples tratamientos sin respuesta, realizándose, cirugía radical con resección en bloque de ombligo, uraco, peritoneo, fascia posterior del musculo recto del abdomen y cistectomía parcial, por abordaje laparoscópico, con excelentes resultados oncológicos y estéticos, con recuperación rápida, y sin complicaciones. El papel de la quimioterapia y radioterapia y su beneficio para el paciente aún no está claro. Con este caso queremos aportar con un nuevo caso a la literatura, además de poder mostrar que el manejo con mínima invasión puede ser adecuada en manos expertas, con resultados iguales a la cirugía abierta, con el beneficio ya conocido del abordaje laparoscópico.

Urachal adenocarcinoma is a rare tumor entity, an average incidence of 1 case per 5 million inhabitants is described. Clinically it manifests with hematuria (73%), abdominal pain (14%), dysuria (13%), mucosuria (10%), irritative symptoms (40%), palpable mass in the lower abdomen (17% ), bacteriuria (8%), umbilical mucosal flow (2%). We present the case of a 45-year-old patient with a diagnosis of urachal adenocarcinoma, who received multiple treatments without response, performing radical surgery with en bloc resection of the umbilicus, urachus, peritoneum, posterior fascia of the rectus abdominis muscle and partial cystectomy. by laparoscopic approach, with excellent oncological and aesthetic results, with fast recovery, and without complications. The role of chemotherapy and radiation therapy and their benefit to the patient is still unclear. With this case we want to contribute a new case to the literature, in addition to being able to show that minimally invasive management can be adequate in expert hands, with results equal to open surgery, with the already known benefit of the laparoscopic approach.

Urachal fistula in a 22 year male: a case report

A patent urachus is one of the spectrums of congenital urachal anomalies. It has been termed as "urachal fistula" when the lumen of intra-embryonic portion of allantois persist abnormally.  Persisting urachal fistula is a rare condition mostly diagnosed during childhood or in autopsies. Here we report a very rare case of urachal fistula of a young male. We present a case of 22 years male with intermittent periumbilical pain and sero-purulent discharge from umbilicus since birth. On examination sero-purulent discharging umbilical sinus with granuloma was present. Surgical excision of whole of the urachal fistulous tract was done with repair of bladder. Patient did well during post-operative period. Persisting urachal fistula in adult is rare entity and difficult to diagnose because of low incidence and non-specific symptoms. So a high index of suspicion is required in order to make the early diagnosis of urachal anomalies.

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.

Persistencia simultánea del conducto uraco y onfalomesentérico en un paciente adulto, reporte de caso / Simultaneous persistence of the urachus and vitelline ducts in an adult patient, case report / Persistência simultânea de úraco e do ducto onfalomesentérico em um paciente adulto: relato de caso

Introducción. La patología umbilical es un tema frecuente en el ámbito pediátrico, la presentación clínica de una fístula umbilical hace pensar en dos patologías mencionadas en la literatura de manera independiente; la primera es la persistencia del conducto onfalomesentérico y la segunda es la persistencia del remanente del uraco producto del fracaso en el cierre de las estructuras embrionarias. Su presencia en adultos es infrecuente y no existen datos estadísticos acerca de su presentación conjunta en población pediátrica o adulta, solo algunos pocos reportes de caso. El diagnóstico se basa principalmente en la sospecha clínica, depende en gran manera del examen físico al evidenciar secreción a través del ombligo al realizar esfuerzos o maniobras de Valsalva. Objetivo. Mostrar un caso infrecuente de la presentación simultánea del conducto de uraco y onfalomesentérico en un paciente adulto. Reporte de caso. Paciente femenina de 24 años de edad con antecedentes de infecciones urinarias y celulitis periumbilicales a repetición. Se sospecha un conducto persistente onfalomesentérico por lo que es sometida a un procedimiento quirúrgico en el que se encontró incidentalmente la persistencia simultánea del conducto onfalomesentérico y persistencia del uraco. Discusión. La persistencia del conducto onfalomesentérico o la persistencia del uraco de forma individual es poco frecuente en adultos, y es aún más raro la persistencia simultánea de ambos conductos; la presencia simultánea de ambos conductos es reportada principalmente en menores de dos años. Conclusiones. La persistencia de estos conductos es rara en adultos y representa un reto diagnóstico para el clínico. Cómo citar: Escudero-Sepúlveda AF, Cala-Duran JC, Belén Jurado MB, Pinasco-Gómez R, Tomasone SE, Roccuzzo C, Domínguez-Alvarado GA. Persistencia simultánea del conducto uraco y onfalomesentérico en un paciente adulto, reporte de caso. MedUNAB. 2020;23(2): 288-293. doi: 10.29375/01237047.3826.

Introduction. Umbilical pathology is a common topic in the pediatric sphere. The clinical presentation of an umbilical fistula leads to the consideration of two pathologies independently reported in literature. The first is a persistent vitelline duct and the second is a persistent urachal remnant as a result of the embryonic structures' failure to close. They are uncommon in adults and there are no statistical data about their presentation together in the pediatric or adult population, only very few case reports. The diagnosis is mainly based on clinical suspicion. It largely depends on a physical examination noting secretion through the navel when straining or performing Valsalva maneuvers. Objective. Show an uncommon case of the simultaneous presentation of the urachus and vitelline ducts in an adult patient. Case report. Female patient aged 24 years with a background of repeated urinary tract infections and periumbilical cellulitis. A persistent vitelline duct is suspected. Therefore, the patient is subject to a surgical procedure in which the simultaneous persistence of the vitelline duct and the urachus was found incidentally. Discussion. The persistence of the vitelline duct or the persistence of the urachus individually is uncommon in adults, and the simultaneous persistence of both ducts is even rarer. The simultaneous presence of both ducts is reported mainly in infants aged under two years. Conclusions. The persistence of these ducts is rare in adults and poses a diagnostic challenge for clinicians. Cómo citar: Escudero-Sepúlveda AF, Cala-Duran JC, Belén Jurado MB, Pinasco-Gómez R, Tomasone SE, Roccuzzo C, Domínguez-Alvarado GA. Persistencia simultánea del conducto uraco y onfalomesentérico en un paciente adulto, reporte de caso. MedUNAB. 2020;23(2): 288-293. doi: 10.29375/01237047.3826.

Introdução. A patologia umbilical é um tópico frequente no cenário pediátrico; a apresentação clínica de uma fístula umbilical faz pensar em duas patologias mencionadas na literatura de forma independente; a primeira é a persistência do ducto onfalomesentérico e a segunda é a persistência do úraco como resultado da falha no fechamento das estruturas embrionárias. É pouco frequente sua presença em adultos e não há dados estatísticos sobre sua apresentação conjunta em população pediátrica nem adulta, apenas alguns poucos relatos de caso. O diagnóstico baseia-se principalmente na suspeita clínica, dependendo em grande parte do exame físico ao evidenciar uma secreção pelo umbigo quando realizar esforço ou manobra de Valsalva. Objetivo. Mostrar um caso infrequente de apresentação simultânea do úraco e ducto onfalomesentérico em um paciente adulto. Relato de caso. Paciente do sexo feminino, 24 anos, com histórico de infecções urinárias e celulite periumbilical recorrentes. Suspeita-se de um ducto onfalomesentérico persistente, portanto ela é submetida a um procedimento cirúrgico no qual encontrou-se a persistência do ducto onfalomesentérico e a persistência de úraco simultaneamente. Discussão. A persistência do ducto onfalomesentérico e a persistência de úraco individualmente é rara em adultos, e a persistência simultânea de ambos os ductos é ainda mais rara; esta presença simultânea é relatada principalmente em crianças menores de dois anos de idade. Conclusão. A persistência desses ductos é rara em adultos e representa um desafio diagnóstico para o profissional de saúde clínico. Cómo citar: Escudero-Sepúlveda AF, Cala-Duran JC, Belén Jurado MB, Pinasco-Gómez R, Tomasone SE, Roccuzzo C, Domínguez-Alvarado GA. Persistencia simultánea del conducto uraco y onfalomesentérico en un paciente adulto, reporte de caso. MedUNAB. 2020;23(2): 288-293. doi: 10.29375/01237047.3826.

Enterourachal Fistula as an Initial Presentation in Crohn Disease / 대한소아소화기영양학회지

Crohn disease has a wide spectrum of clinical presentations and rarely can present with complications such as a bowel stricture or fistula. In this case report, we describe a 17-year-old male who presented with a history of recurrent anterior abdominal wall abscesses and dysuria. He was diagnosed with Crohn disease and also found to have a fistulous communication between the terminal ileum and a patent urachus. An ileocecectomy with primary anastomosis and complete resection of the abscess cavity was performed. He is on azathioprine for maintenance therapy and currently in remission. Clinicians should have a high index of suspicion for this complication in Crohn disease patients presenting with symptoms suggestive of urachal anomalies such as suprapubic abdominal pain, dysuria, umbilical discharge, and periumbilical mass.

Serum immunoglobulin from Nellore cattle produced by in vitro fertilization and treated for umbilical diseases / Imunoglobulinas séricas de bovinos Nelore produzidos por fertilização in vitro e tratados para onfalopatias

The aim of this study was to measure serum immunoglobulin concentrations of Nellore cattle produced by in vitro fertilization (IVF) with umbilical diseases and to evaluate surgical excision as a method of treatment. Sixteen cattle with ages ranging from 1 to 15 months, males and females, affected by umbilical diseases were enrolled in the study. Blood samples were collected for cell counts and the determination of immunoglobulin concentrations by electrophoresis and zinc sulphate turbidimetry (ZST). Four calves were presented with umbilical herniation, two with an umbilical herniation associated with a persistent urachus, two with an umbilical herniation with a persistent urachus and omphaloarteritis, three with an umbilical herniation and an urachal diverticulum, three with a persistent urachus, one with an urachal diverticulum, and one with omphalitis. The blood cell counts pre- and post-surgical revealed differences in cell volume and the number of leukocytes. The immunoglobulin values measured by electrophoresis values were below normal in most animals, whereas the ZST showed normal levels in most of them. Most of the calves affected by umbilical diseases and produced by IVF presented hypoglobulinaemia. Correlations between umbilical diseases, failure of passive transfer of immunity and IVF could not be demonstrated.(AU)

Os objetivos desse estudo foram mensurar as concentrações séricas das imunoglobulinas de bovinos Nelore, produzidos por fertilização in vitro (FIV), acometidos por onfalopatias e avaliar a excisão cirúrgica como método de tratamento. Utilizou-se 16 animais, com idade variando de 1 a 15 meses, machos e fêmeas, acometidos por afecções umbilicais. Amostras de sangue foram colhidas para realização de hemogramas e avaliação das imunoglobulinas, por meio de eletroforese e turbidimetria com sulfato de zinco. Foram observados quatro casos de hérnias umbilicais, dois de hérnia umbilical associadas à persistência de úraco, dois casos de hérnia umbilical com persistência de úraco e onfaloarterite, três de hérnia umbilical com divertículo de úraco, três casos de persistência de úraco, um de divertículo de úraco e um de onfalite. O hemograma revelou diferença significativa para os valores de Volume Globular e Leucócitos, nos momentos pré e pós-tratamento cirúrgico dos animais. A eletroforese evidenciou valores de imunoglobulina abaixo da normalidade na maioria dos animais, enquanto que a turbidimetria apresentou níveis normais na maioria dos bovinos, quando comparados com valores de referência. A maioria dos bovinos estudados, acometidos de onfalopatias e concebidos por FIV, apresentaram hipoglobulinemia. Os resultados obtidos não permitem afirmar que existe relação entre as onfalopatias, falha de transferência de imunidade passiva e FIV.(AU)

Adenocarcinoma de uraco: presentación de dos casos / Urachal adenocarcinoma: report of two cases

OBJETIVOS: Revisión de la literatura del Adenocarcinoma de uraco y presentación de dos casos MÉTODOS/RESULTADOS: Analizamos las características epidemiológicas, clínicas y terapéuticas del Adenocarcinoma de uraco y presentamos dos casos diagnosticados y tratados en nuestro centro CONCLUSIONES: El Adenocarcinoma de uraco es una neoplasia rara, con mal pronóstico y cuyo tratamiento generalmente es la cistectomía parcial o radical con resección en bloque del uraco y el ombligo. Debido a su gravedad, debería tenerse en cuenta a la hora del diagnóstico.AU

OBJECTIVE: Literature review of Urachus adenocarcinoma and report of two cases. METHODS/RESULTS: We analyze epidemiological, clinical and therapeutic features of the Urachus adenocarcinoma and we report two cases diagnosed and treated in our institution. CONCLUSIONS: The Urachus adenocarcinoma is a rare cancer, with poor prognosis and treatment of which usually is radical or partial cystectomy with umbilicotomy and removal of the urachus in bloc. Due to its gravity, you should keep it in mind when you make a diagnosis.AU

Omphalomesenteric cyst and patent urachus in a 29-year-old male

@#Small bowel obstructions are commonly caused by bowel adhesions from previous intra-abdominal surgeries.1 Bowel obstructions in adults that are caused by the presence of vestigial embryonic structures are unusual.2 Omphalomesenteric duct and urachus are primitive embryonic structures, which normally involute between the 5th and 12th week of gestation.3 4 Failure to involute leads to anomalies such as patent ducts and omphalomesenteric cysts.2 5 6 7 Omphalomesenteric duct remnants are present in at least 2% of the population.2 Among the urachal remnants, a patent urachus is less common, only accounting for 15% of the cases.8 Simultaneous occurrence of both remnants is rare.5 Diagnostic imaging, such as ultrasonography, is usually performed to facilitate planning for subsequent management of patients who present with chronic symptoms related to the persistence of these remnants.9 Computed tomography may also be done to determine the location, size and patency of ducts and cysts, while voiding cystourethrograms can be used to determine bladder wall involvement.8 However, among undiagnosed patients who present with acute bowel obstruction, the presence of these remnants is usually established intraoperatively during exploratory laparotomy. The approach to treatment involves excision of the remnants and appropriate surgical management of the bowel obstruction.1 2 5 6 10 11 Prognosis is often good with uneventful postoperative recovery.1 2 5 A 29-year-old male came to our emergency room complaining of generalized, vague abdominal pain, gradual abdominal distension, post-prandial vomiting of previously eaten food, obstipation, and fever within 48 hours before consultation. The patient did not report any history of weight loss or gastrointestinal symptoms prior to the onset of the present problem. On physical examination, the patient was tachycardic and showed signs of an acute abdomen. Digital rectal examination showed an empty rectal vault, with no masses or bleeding noted. Laboratory findings revealed leukocytosis at 18.3 x 103/µL and normal serum electrolyte levels. Upright and supine abdominal x-rays showed dilated bowel loops with thickened serosa and multiple air-fluid levels (Figure 1A, 1B). We did an exploratory laparotomy with a working diagnosis of complete intestinal obstruction. Intraoperatively, we noted torsion of the ileum (Figure 1C) around a band, which runs from the ileum approximately 80 cm from the ileocecal valve, to the umbilicus. The band, an omphalomesenteric remnant, contains a cyst measuring 10 x 4.7 x 3 cm. (Figure 1D). We also noted a patent urachus inferior to the omphalomesenteric remnant, connecting the bladder to the umbilicus (Figure 1E). We detorted the bowels manually, resected the portion of the ileum where the omphalomesenteric remnant was attached, and did a double-barrel ileostomy. We excised the urachal remnant and performed cystorrhaphy and umbilicoplasty. The patient had an unremarkable postoperative recovery. Ileal anastomosis was planned to take place around 6 weeks postoperatively. Given the unexpected intraoperative findings of persistent embryonic structures, we asked the patient postoperatively about history of related symptoms. The patient denied of recurrent urinary tract infections in the past, but he claimed to have intermittent umbilical wetness with non-foul-smelling discharge, which spontaneously resolved after a few years, when he was a teenager. Omphalomesenteric remnants can be a cause of intestinal obstruction in adults with no previous history of surgery. A history of symptoms related to the presence of the remnants is rarely elicited preoperatively. Excision of the remnants with appropriate repair of affected structures and adequate management of the intestinal obstruction usually resolves the problem.

Recurrent Abdominal Wall Inflammation After Resection of Urachal Xanthogranuloma

We report a very rare case of urachal xanthogranuloma. In this case, the inflammation recurred after 9 months even though it was removed by surgical resection. A 43-year-old woman presented with low abdominal walnut sized round mass, mild abdominal pain, and no specific voiding symptoms. Through radiologic evaluation with computed tomography (CT), we observed an infiltration in surrounding tissues of urachal mass from anteriosuperior aspect of bladder until umbilicus, so urachus inflammation as well as malignant tumor of urachus origin was suspected. Urachal mass excision and partial cystectomy were conducted with low midline incision and it was reported pathologically as xanthogranulomatous inflammation. Afterwards the patient lived without inconvenience but after 9 months she returned because of pain and palpable nodule in the right lower abdominal area. Despite taking antibiotics, there was no improvement and abscess formation was observed in CT. Finally, its symptoms improved after abscess incision and drainage.

Complete androgen insensitivity syndrome associated with vesical fistula:a case report and literature review / 北京大学学报(医学版)

Androgen insensitivity syndrome (AIS) is a very uncommon genetic disorder that results from the resistance of androgen receptor (AR) to androgen, which influences the formation of the male genitalia and in turn presents with female phenotype.Surgical resection of undesceaded testicle and different kinds of genitoplasty are crucial methods to correct the deformity of reproductive system, as well as hormone replacement therapy, which is an essential therapy for postoperational rehabilitation in AIS patients.A 43-year-old patient, who was socially female, was first admitted to gastroenterology department due to recurrent ascites and occasional abdominal pain with unknown origin.Taking physical examination, ultrasonography, karyotype analysis and sex hormone levels into consideration, the overall manifestations revealed the typical clinical features of complete androgen insensitivity syndrome.After that she was transferred to urology department for laparoscopic gonadectomy.During the surgery, doctors found that there was a vesical fistula on the upper wall near the conjunction between the bladder and ligamenta umbilicale medium, which explained the recurrent ascites for more than 4 years.After resecting the testicles and the tissues around the vesical fistula for histopathology, the result suggested Sertoli cell adenoma, hyperplastic Leydig cells and urothelium atypical hyperplasia.Hormone replacement therapy was given right after discharge.The hormone levels of follicle-stimulating hormone, luteinizing hormone, estradiol and progesterone were modulated by the dysfunction of androgen production after gonadectomy and hormone replacement therapy together with psychotherapy could stabilize her hormone levels and improve the quality of her life.The patient was suspicious of AIS family history and the pedigree was made to analyze her family which was possibly X-linked recessive pattern.We propose three possible hypotheses of the fistula, which are direct surgical injury, recurrence of bladder cancer and congenital urachal anomalies.But whether it is relevant between urachal anomalies and AIS is yet to be discovered.

Urachal adenocarcinoma of bladder: clinical analysis of six cases / 中华全科医师杂志

The clinical and pathological data of 6 patients with urahcal adenocar,cinoma of the bladder admitted in Beijing Luhe Hospital from 1996 to 2016 were analyzed and relevant literature was reviewed.Urachal carcinoma accounted for 0.66% of the bladder cancers admitted at the same period (6/906) and 6/16 of the bladder adenocarcinomas.Painless hematuria was the most common symptom.One patient had extensive metastasis as shown in biopsy and died 6 month after the diagnosis.Two patients underwent partial excision of bladder with no tumor recurrence.One patient underwent partial cystectomy followed by chemotherapy and radiotherapy, recurrence occurred one year later and he then received radical cystectomy.Another 2 patients underwent laparoscopic cystectomy and en bloc resection of umbilical ligament and umbilicus, and no recurrence was found in the follow-up for 6 years and 15 months, respectively.Pathological and immunohistochemistry are essential for the diagnosis of urachal adenocarcinoma.As it is not sensitive to radiotherapy or chemotherapy,surgery is the preferred treatment for patients with early stage diseases.Individual anticancer therapy may be the trend of treatment.

Anaplastic lymphoma kinase positive inflammatory myofibroblastic tumor of the urachus: A rare neoplasm in an unusual location.

Inflammatory myofibroblastic tumors (IMTs) are uncommon benign neoplasms in the abdomen, and urachal involvement is very rare. IMT of the urachus is usually mistaken clinically and radiologically for a malignant tumor. The tumor has spindle cell proliferation with a prominent inflammatory infiltrate and myxoid degeneration favoring other designations such as inflammatory pseudotumor and fibromyxoid pseudotumor. Complete excision is the treatment of choice. The case documented here was in a 50‑year‑old male, with an abdominal mass diagnosed on computed tomography scan as adenocarcinoma of urachus infiltrating the bladder. Histopathology showed a benign spindle cell tumor invading bladder muscle. Immunohistochemistry aided in diagnosing an anaplastic lymphoma kinase (ALK)‑1 positive IMT. Approximately, 50% of the IMTs show ALK positivity, and though when present, it indicates neoplastic nature of the spindle cells, the pathogenesis of IMT is still elusive. The urachal IMTs need documentation in literature for their rarity and diagnostic dilemma posed by them.

Xanthogranulomatous cystitis with pelvic lymph node hyperplasia case report and literature review / 重庆医学

Objective To decrease the error and missed diagnosis of xanthogranulomatous cystitis(XC) .Methods Combined with laboratory and imaging examnation ,we considered the diagnosis of urachal carcinoma complicated by urinary track infection . Anti-infection treatment before surgery ,we removaled of the pathological tissues ,and the final diagnosis was XC .Results The clin-ical symptoms of XC was not typical ,and this case was similar to that of urachal carcinoma .Cystoscope and imaging examination had no specificity .There were not frequent micturition ,the the urgency of urination and low back pain of patiut of the patient by one year follow-up .Conclusion XC is very rarely ,and it is hard to differentiate from other bladder diseases ,tumor of the urachus .The final diagnosis may still depends on histopathological examination .

Patología del ombligo / Pathology navel

El cordón umbilical, tan vital en la vida intrauterina, no tiene una función fisiológica en el ser humano después del nacimiento. Entre los primeros 10-20 días de vida del recién nacido requiere de cuidados que el pediatra y personal de salud que realiza los controles debe indicar a la madre para asegurar que el proceso de desecación y eliminación del cordón se complete de forma apropiada. Sin embargo, aun cuando la madre haya seguido correctamente las indicaciones, existen posibilidades de que la evolución clínica no sea la normal y la cicatrización se retarde o complique. Las posibilidades que el clínico debe sospechar son bastante variadas dentro de un espectro que va desde patologías leves hasta aquellas más complejas que incluyen alteraciones del desarrollo intrauterino con resultado de malformaciones congénitas. El propósito de este artículo es revisar la literatura publicada al respecto y actualizar aspectos clínicos importantes que el pediatra o médico que atiende niños debe conocer para orientar correctamente el diagnóstico y oportunidad terapéutica.

The umbilical cord, is a vital structure in utero, but it has no one physiological function in humans after birth. Among the first 10-20 days old newborn baby requires care pediatrician and health staff should learn to the mother how she must be care to make the drying process and complete removal of the cord can be appropriate. However, even if the mother has correctly followed the instructions, there are chances that the clinical course than the normal healing is delayed or complicated. The chances that the clinician should suspect are quite varied within a spectrum from mild to the most complex pathologies including disturbances of intrauterine development resulting in congenital malformations. The purpose of this article is to review the published literature and update important clinical aspects pediatrician or physician who treats children should learn to correctly orient the diagnosis and therapeutic opportunity.

Neoplasia de úraco: relato de caso / Urachal neoplasia: a case report

As doenças dos remanescentes do úraco são incomuns. Localizam-se geralmente na junção remanescente do úraco com a cúpula vesical. Adenocarcinomas mucinosos são a maioria. A característica clínica mais comum é a hematúria. Neste artigo relatamos o caso de uma paciente de 62 anos com quadro de hematúria macroscópica com evolução de três anos. São descritos achados na ultrassonografia e tomografia computadorizada.

Diseases of urachal remnants are uncommon and generally located on the junction of the urachal remnant with the bladder dome. In most cases such diseases correspond to mucinous adenocarcinomas and present hematuria as their most common clinical finding. The authors report the case of a 62-year-old female patient undergoing follow-up due to macroscopic hematuria for three years. Ultrasonography and computed tomography findings are described.

Avaliação ultrassonográfica da involução das estruturas umbilicais extra e intracavitárias em bezerros sadios da raça Nelore concebidos naturalmente e produtos de fertilização in vitro / Ultrasound evaluation of extra- and intra-abdominal umbilical structures involution in healthy Nelore calves products of natural conception or in vitro fertilization

Esse trabalho foi desenvolvido com o objetivo de caracterizar a involução das estruturas umbilicais em bezerros sadios da raça Nelore ao longo dos primeiros 35 dias de vida, e de comparar esse processo em bezerros concebidos por métodos naturais ou por fertilização in vitro (FIV). Quarenta bezerros foram distribuídos em dois grupos (n=20) de acordo com o método de concepção (natural ou FIV) e cada grupo foi composto por dez machos e dez fêmeas. A ultrassonografia (transdutor microconvexo de 7,5 MHz) foi empregada para examinar o conjunto das estruturas remanescentes do cordão umbilical que compõem o umbigo externo e as estruturas abdominais (veia umbilical, artéria umbilical esquerda e ducto alantóide), mensurando-se os seus diâmetros em locais definidos. Os exames foram realizados entre 24 e 36 horas de vida e aos 7, 14, 21, 28 e 35 dias de idade. Testaram-se os efeitos do sexo, da idade e do método de concepção por meio da análise de variâncias de medidas repetidas. O exame ultrassonográfico provou-se adequado para a avaliação das estruturas umbilicais extra e intracavitárias permitindo a caracterização do processo fisiológico de involução das mesmas. No umbigo externo, as veias umbilicais foram observadas como imagem individualizada até os 14 dias de vida e um conjunto de estruturas em processo de atrofia era visualizado após essa idade. No abdômen, a veia e a artéria umbilicais foram visualizadas até os 35 dias de idade e o ducto alantóide somente durante a primeira semana de vida. Essas estruturas apresentaram-se com parede hiperecóica regular e contínua e lúmen homogeneamente anecóico. O diâmetro de todas as estruturas umbilicais estudadas se reduziu continuamente ao longo do primeiro mês de vida (p<0,05), sem efeito do sexo (p>0,05). Comparados aos bezerros concebidos por métodos naturais, os produtos de FIV nasceram com os vasos umbilicais e o ducto alantóide um pouco mais calibrosos (diâmetros 1 a 3 mm maiores). Distintamente dos valores ...

This study was carried out to characterize the involution of the umbilical cord structures in healthy Nelore calves during their first 35 days of life, and to compare this process in calves conceived by natural methods or by in vitro fertilization (IVF). Forty calves were separated in two groups (n=20) according to their conception method (natural or IVF) and each group consisted of ten male and ten female calves. The ultrasound (7.5 MHz micro convex transducer) was used to examine all the remaining structures of the umbilical cord that make the external navel and the abdominal structures (umbilical vein, left umbilical artery and allantoic duct), and their diameters were measured in distinct locations. The examinations were performed between 24 and 36 hours of life and at 7, 14, 21, 28 and 35 days of age. The effects of sex, age and method of conception were tested by repeated measures ANOVA. The ultrasound examination was suitable for evaluation of extra- and intra-abdominal umbilical structures and characterization of its involutive physiological process. Both veins were visualized in the external umbilicus up to 14 days of life and set of structures in process of atrophy were seen after this age. In the abdomen, the artery and the vein could be examined up to 35 days of age, and the allantoic duct only during the first week of life. These structures showed a regular and consistent hyperechoic wall and a homogeneous anechoic lumen. The diameter of all studied structures decreased throughout the first month of life (p<0.05) without any sex effect (p>0.05). The umbilical vessels and the allantoic duct were slightly wider (diameter 1-3 mm larger) in calves conceived by IVF. Differently from the highest values previously demonstrated for Bos taurus calves, we can disclose that in healthy newborn Nelore calves the thickness of the structures which make the external navel should not exceed 2 cm, the diameter of the umbilical vein and artery ...

Tuberculosis of the urachal cyst

Urachal cysts are uncommon. Rarely, these cysts can become infected. Tuberculosis of the urachal cyst is exceedingly rare, with only one case reported previously in the English language literature. Here we report the case of a 23-year-old male who presented with an infra-umbilical mass that turned out to be tuberculosis of the urachal cyst.

Adenocarcinoma de úraco: relato de dois casos / Urachal adenocarcinoma: a report of two cases

O adenocarcinoma de úraco é uma neoplasia incomum associada a prognóstico reservado. Realiza-se estudo clínico e anatomopatológico de dois casos de adenocarcinoma de úraco: um homem de 63 anos de idade que apresentou recidiva tumoral após cistectomia parcial aberta e evolução desfavorável; e uma mulher de 55 anos, submetida à cistectomia parcial videolaparoscópica, que se encontra em seguimento livre de recidiva.

Urachal adenocarcinoma is an uncommon neoplasm associated with poor prognosis. A clinical and pathological study of two cases of urachal adenocarcinoma is presented: a 63-year-old man with tumoral recurrence after open partial cystectomy and unfavorable evolution; a 55-year-old woman who underwent laparoscopic partial cystectomy without recurrence in the follow up.