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.

Clinical Analysis of Urachal Anomalies

PURPOSE: Although relatively rare, urachal remnants manifest as a large number of diverse disorders, which can lead to a high misdiagnosis rate. Because of the many clini-cal pre-sentations, there are no uniform guidelines for the evaluation and treatment of urachal remnants. We report our experi-ence with urachal anomalies in an attempt to establish an optimal diagnostic and treatment modality. METHODS: Fifteen patients (6 males and 9 females), who had undergone surgery for urachal anomalies from December 1988 to July 2004, were analyzed retrospectively. RESULTS: The patients' age ranged from 1 day to 71 years old. The 3 variants of urachal anomalies included a patent urachus in 1 patients (7%), urachal sinus in 5 (33%), and an urachal cyst in 9 (60%). The presenting complaint was a low abdominal mass in 6 patients, abdominal pain in 5, periumbilical discharge in 3, fever in 3, and periumbilical urination in 2. Four combined anomalies were observed in 4 patients. The diagnostic evaluation included fistulography in 3 cases, sonography in 12, and CT in 3. Excision was performed in 12 patients. CONCLUSION: Urachal anomalies most often present in infancy, and can be diagnosed and treated with certainty if a good physical examination and proper imaging studies are performed. Surgical excision is the treatment of choice for urachal anomalies.

Urachal Anomalies in Children

Failure of the urachus to regress completely results in anomalies that may be classified as patent urachus, urachal sinus, urachal cyst and bladder diverticula. The presenting symptoms of children with urachal anomalies are variable and uniform guidelines for diagnosis and treatment are lacking. The purpose of this study was to elucidate our conclusions regarding the presentation, diagnosis and treatment of urachal anomalies by reviewing our experiences. We retrospectively analyzed the records of 32 patients who were admitted for urachal anomalies from March 1995 to February 2005. The age distribution of these patients at presentation ranged from 1 day to 14 years old (median age 1 month) and they included 20 boys and 12 girls. The 32 cases comprised 13 cases of urachal sinus (40.6%), 10 urachal cyst (31.3%), and 9 patent urchus (28.1%). The presenting symptoms were umbilical discharge (14 patients), umbilical granuloma (8), abdominal pain and fever (3), fever (3), abdominal pain (2), and a low abdominal mass (2). In 30 patients ultrasonography was used for diagnosis and 2 patients with patent urachus were explored without using a diagnostic method. Twenty-three patients were confirmed by ultrasonography alone and 7 patients were examined using additional modalities, namely, computed tomography for 2 patients with an urachal cyst, magnetic resonance imaging for 1 patient with an urachal cyst, and fistulography for 3 patients with an urachal sinus. Excision was performed in 29 patients, and 3 patients were conservatively managed. Urachal anomalies in children most frequently presented in neonates, and the most common complaint was umbilical discharge with infection. Urachal anomalies can be diagnosed by a good physical examination and an appropriate radiographic test, and ultrasound was found the most useful diagnostic method. Complete surgical excision of an urachal anomaly is recommended to avoid recurrence, and even, though rare, carcinoma development.

A Clinical Observation of Children with Urachal Anomalies

PURPOSE: Urachal anomalies are rare but are known to develop several complications, especially infection. Moreover, uniform guidelines for management have not been presented because of the variable clinical characteristics of these anomalies. The purpose of this report is to review our experience with urachal anomalies and attempt to determine the optimal management. METHODS: We retrospectively reviewed the records of fourteen children with a variety of urachal anomalies who had been treated from January 1996 to June 2005 at Dong Kang General Hospital. RESULTS: The age distribution of the patients(mean age; 3.8 years) was six neonates, one infant, five preschool-age and two school-age children. The male to female ratio was 1:1. Six cases of urachal cyst, four cases of patent urachus, two cases of urachal sinus and two cases of urachal diverticulum were found. Three patients with patent urachus and one with urachal cyst had hydronephrosis. Other associated anomalies included an inguinal hernia in one patient with urachal sinus and a vesicoureteral reflux in one patient with urachal diverticulum. As a first-line diagnostic tool, high-resolution ultrasound examination was performed in thirteen cases and computed tomography in one case. Surgical excision was performed in nine patients with urachal anomaly. Five cases out of six neonatal cases experienced spontaneous improvement during a three-month follow up period. Due to frequent infection of the umbilicus, surgical excision was performed on one neonate with urachal sinus. CONCLUSION: All patients with urachal anomalies should undergo investigation for associated anomalies. The neonate with urachal anomalies, especially patent urachus, do not require surgical excision unless the patient has multiple episodes of recurrent infection.

A Case of Patent Urachus / 대한산부인과학회잡지

Patent urachus results when there is a persistence of an allantosis remnant which normally undergoes atresia during embryological development. Failure of urachal obliteration may result in 4 different types of urachal remnants: complete patency or vesicoumbilical fistula, vesicourachal diverticulum, urachal sinus and urachal cyst. In prenatal ultrasound, we found a large cyst in the umbilical cord. At term, the patient underwent primary cesarean section with delivery of a 3100 g female infant. After delivery, we found the communication of urinary bladder by fistulogarm. The infant underwent repair and closure of the patent urachus.

Clinical Analysis of Urachal Anomalies

PURPOSE: Although urachal anomalies are rarely observed clinically, they often give rise to a number of problems, such as infection and late malignant changes. Because of variable clinical presentations, uniform guidlines for evaluation and treatment are lacking. The authors discuss the problems involved in both the diagnosis and the treatment of these anomalies. METHODS: We retrospectively analyzed 15 patients (9 males and 6 females) who had undergone surgery for urachal anomalies from July 1995 to December 1999. RESULTS: The age distribution ranged from 14 days to 38 years old, and the male to female ratio was 1.5:1. The 4 variants of urachal anomalies included a urachal sinus in 7 patients (47%), a urachal cyst in 4 (27%), a patent urachus in 3 (20%), and a bladder diverticulum in 1 (6%). The presenting complaint was periumbilical discharge in 6 patients, fever in 5, umbilical granuloma in 4, low abdominal mass in 3, and low abdominal pain in 1. Eight combined anomalies were seen in 7 patients; 2 umbilical hernias, 1 inguinal hernia, 1 hydrocele, 1 urachal vessel anomaly, 1 vesicoureteral reflux, 1 hydronephrosis, 1 Hirschsprung's disease, and 1 hypertrophic pyloric stenosis. Ultrasound examination disclosed a cyst or a sinus in 5 patients, and CT was performed in 1 case. Excision was performed in all patients, and there was no postoperative complication or recurrence. CONCLUSION: Urachal anomalies most frequently present in infancy or childhood, and the initial presentation is umbilical discharge with infection. Furthermore, the large number of associated genitourinary and gastrointestinal anomalies suggests that a complete work-up for these conditions should be performed. Definitive surgical excision appears to be appropriate for most patients.

Clinical Analysis of Urachal Anomalies

PURPOSE: Although urachal anomalies are rarely observed clinically, they often give rise to a number of problems, such as infection and late malignant changes. Because of variable clinical presentations, uniform guidlines for evaluation and treatment are lacking. The authors discuss the problems involved in both the diagnosis and the treatment of these anomalies. METHODS: We retrospectively analyzed 15 patients (9 males and 6 females) who had undergone surgery for urachal anomalies from July 1995 to December 1999. RESULTS: The age distribution ranged from 14 days to 38 years old, and the male to female ratio was 1.5:1. The 4 variants of urachal anomalies included a urachal sinus in 7 patients (47%), a urachal cyst in 4 (27%), a patent urachus in 3 (20%), and a bladder diverticulum in 1 (6%). The presenting complaint was periumbilical discharge in 6 patients, fever in 5, umbilical granuloma in 4, low abdominal mass in 3, and low abdominal pain in 1. Eight combined anomalies were seen in 7 patients; 2 umbilical hernias, 1 inguinal hernia, 1 hydrocele, 1 urachal vessel anomaly, 1 vesicoureteral reflux, 1 hydronephrosis, 1 Hirschsprung's disease, and 1 hypertrophic pyloric stenosis. Ultrasound examination disclosed a cyst or a sinus in 5 patients, and CT was performed in 1 case. Excision was performed in all patients, and there was no postoperative complication or recurrence. CONCLUSION: Urachal anomalies most frequently present in infancy or childhood, and the initial presentation is umbilical discharge with infection. Furthermore, the large number of associated genitourinary and gastrointestinal anomalies suggests that a complete work-up for these conditions should be performed. Definitive surgical excision appears to be appropriate for most patients.

A Clinical Study of Urachal Remnants

The embryological and anatomical features of urachal anomalies have been well defined. Because of the variable clinical presentation, uniform guideline for evaluation and treatment are lacking. Although urachal remnants are rarely observed clinically, they often give rise to a number of problems such as infection and late malignant changes. Therefore, a total assessment of the disease with a particular focus on embryology, anatomy and clinical symptoms, as well as the most advisable management, is called for. Twenty six patients with urachal remnants were treated at the Department of Pediatric Surgery from August 1980 to June 1998. Of these 26, 9 were classified as patent urachus, 11 as urachal sinus, 4 urachal cyst, 1 urachal diverticulum and 1 alternating sinus. The group consisted of 11 males and 15 females. The age distribution was 20 neonates, 3 infants, 2 preschoolers and 1 adult. Infection was the most frequent complication and Staphylococcus aureus was the predominant causative microorganism. Fistulogram was performed in 4 cases and ultrasound examination disclosed cysts or sinus in 7 cases. Excision was performed in 24 patients and incision and draniage in 2 cases as a primary treatment. There was no postopreative complication or recurrence.

Congenital Patent Urachus: Report of 2 Cases / 대한비뇨기과학회지

The congenital patent urachus is the failure of complete urachal lumen closure and results in a free communication between the bladder and the umbilicus. Embriologically the urachus represents the vestigial remnant of the allantois which, in the fetus, communicates with the cloaca. The first patient is a 6-day-old female infant, and she was transferred due to urine leakage from the reddish hen egg sized protruding mass on the umbilicus. The fistulogram showed a long fistulous tract which communicates with bladder and umbilicus. A complete resection of the patent urachus was done. The second patient is a 1-day-old male infant, and he was transferred for operation of omphalocele from local clinic. Urine leakage was detected from the urachus at operative field, and so complete resection of the urachus was performed, and the one stage repair was performed for treatment of mild intestinal herniation. Postoperative courses of the two cases were uneventful.

A Case of Congenital Patent Urachus / 대한비뇨기과학회지

The patent urachus results from failure of luminal closure of the urachus. Embryologically, the urachus represents the vestigial remnant of the allantois which, in the fetus, communicates with the cloaca. The authors report a case of congenital patent urachus with review of some literatures.

A Case of Patent Urachus

Pateat urachus is a uncommon disease and it has a good prognosis if there is no combired major anomaly and evidence of malignancy. This paper presents one case of patent urachus which was found and removed surgically during the neonatal period. A brief review of related literatures is also presented.

A Case of Congenital Patent Urachus / 대한비뇨기과학회지

Urachal anomalies are very rare. Since Cabrolius' report of patent urachus in 1550, only 315 cases have been collected in the literature. Failure of the urachal lumen to close and completely obliterate causes one of several anomalies. These have been classified into four distinct entities by Blichert-Tott and Neilsen, Who also tabulated the incidence of each variant in the 315 reported cases : patent urachus , 48 per cent ; urachal cyst , 31 percent ; urachal sinus or alternating sinus, 18 per cent , and vesicourachal diverticulum, per cent . A brief discussion of embryology, symptoms , histopathology , diagnosis and treatment is made and a case of congenital patent urachus is reported here at Korea General Hospital.

Complete Patent Urachus: Report of a Case / 대한비뇨기과학회지

Complete patent urachus is a congenital anomaly that remains Open by fistulous tract extending from the bladder to umbilicus even after birth and rarely observed in literatures. We have experienced a case of complete patent urachus and reported with review of some literatures.

A case of Congenital patent urachus / 대한비뇨기과학회지

The complex group of changes which occurs during the intrauterine maturation of the urinary tract gives rise to several anomalies including those of the urachus. The occurrence of patent urachus is very rare and 67 cases has been reported by world literature since 1550, first description of patent urachus by Bartholomaeus Gabriolus A brief discussion of embryology, diagnosis and treatment is included for completeness. And a case of congenital patent urachus was seen at Han Ill Hospital.