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

Quiste de uraco complicado. Diagnóstico diferenciaI de abdomen agudo. Reporte de un caso / Cyst of urachus complicated. Differential diagnosis of abdomen acute. Case report

Reporte de caso: La literatura manifiesta que el quiste de uraco es raro, por lo cual el diagnóstico es aún más difícil de establecer, debido a que solo se presentan síntomas cuando ya existe una complicación, por tanto se puede suponer que algunas personas sean poseedoras de un quiste de uraco y sin presentar sintomatología, siguen con sus actividades de la vida sin problemas. A continuación, presentamos el caso de una paciente, que ingreso con una clínica sugerente de abdomen agudo por apendicitis, pero los exámenes de imágenes revelaron otro diagnóstico, confirmándose con la intervención quirúrgica y posteriormente anatomía patológica. (AU)

Case report: The literature states that the urachus cyst is rare, so the diagnosis is even more difficult to establish, because symptoms only manifest when a complication already exists, so it can be assumed that many people have a urachus cyst, and without having symptoms, they continue with their life activities without problems. Next, we present the case of a patient, who admitted to a clinic suggestive of an acute abdomen due to appendicitis, but the imaging tests revealed another diagnosis, confirming with the surgical intervention and subsequently pathological anatomy. (AU)

Caso Clínico: Quiste de Uraco en un Paciente Adulto, Resolución Laparoscópica / Case Report: Urachal Cyst of an Adult Patient, Laparoscopic Resolution

INTRODUCCIÓN: La patología por remanente de uraco representa un fracaso en el proceso de obliteración, es una anomalía rara congénita que se diagnostica en el 1.6 % de los niños menores a 15 años y en el 0.063 % de los adultos. CASO CLÍNICO: Paciente de 42 años, sexo masculino, intervenido por laparoscopía por apendicitis aguda complicada. Durante el procedimiento se encontró una masa a nivel de la pared abdominal anterior en contacto con la vejiga. Mediante exámenes complementarios se diagnosticó quiste de uraco. EVOLUCIÓN: Se planificó la exéresis del quiste de uraco por vía laparoscópica, el procedimiento se realizó sin complicaciones obteniéndose un quiste de 6 x 4 cm de diámetro, remanante del ligamento umbilical. No fue necesaria la resección de la cúpula vesical. El posquirúrgico evolucionó de manera favorable y el paciente se mantuvo hospitalizado durante 2 días antes de ser dado de alta. CONCLUSIÓN: La resolución laparoscópica es una técnica segura y efectiva de elección para la exéresis del quiste del uraco en adultos. Presenta ventajas en relación a la cirugía convencional por la disminución del riesgo de infección del sitio quirúrgico, disminuye el dolor posquirúrgico, disminuye la estancia hospitalaria y permite la reincorporación laboral temprana.(au)

BACKGROUND: Remnant urachal pathology represents an obliteration failure, it is a rare congenital anomaly diagnosed in 1.6 % of under 15-years and 0.063 % of adult patients. CASE REPORT: A 42-years old male patient who underwent laparoscopic surgery because of an acute complicated appendicitis. During procedure, a mass was found near to anterior abdominal wall, it had contact with the urinary bladder's wall. Complementary exams were performed and an urachal cyst w pically and was found to be an incidental mass at the level of the anterior abdominal wall in acontact with the bladder. Urachal cyst was diagnosed based on complementary studies. EVOLUTION: Laparoscopic exeresis of the urachal cyst was planned. The procedure had no complications and a 6 x 4 cm urachal cyst was obtained (umbilical ligament remnant). Urinary bladder's dome resection was not required. The postoperative was favorable and the patient stood hospitalized for 2 days before he was discharged. CONCLUSION: Laparoscopic resolution is a safe and effective technique to perform an urachal cyst exeresis in adults. It has some advantages over conventional surgery as lower surgical site infection risk, less postoperative pain, shorter hospital stay and early return to work.(au)

Urachal abscess precipitated as acute pyelonephritis in an adult patient with diabetes

No abstract available.

Laparoscopic Management of Complicated Urachal Remnants / 전남의대학술지

Managing persistent and symptomatic urachal anomalies requires wide surgical excision of all anomalous tissue with a cuff of bladder tissue via the open approach. We report 7 cases with complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue. We expected that this technique would be less invasive and have lower morbidity. We report on the feasibility of this approach, including efficacy and outcomes. Eight patients with a mean age of 36.5 years who had symptomatic urachal diseases underwent laparoscopic excision between July 2004 and July 2012. With the use of four ports, the urachal remnant was dissected transperitoneally and then removed via the umbilicus port. The clinical results of laparoscopic urachal remnant excision as a minimally invasive surgery, the perioperative records, and pathologic results were evaluated. There were no intraoperative or postoperative complications. Mean surgery time was 2.7 hours. Mean hospital stay was 14.6 days. The patients with bladder cuff resection had a long admission and Foley catheterization period (mean, 14.4 and 11 days). Pathological evaluations were 6 cases of infected urachal cysts, 1 case of infected urachal sinus, and 1 case of urachal adenocarcinoma. We found no postoperative complications including any symptom recurrence or voiding difficulty during a mean follow-up of 46.3 months. The perioperative surgical outcomes achieved infection control and symptomatic relief and additionally good cosmesis. Complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue seems to be a safe, effective, and better cosmetic alternative with the advantages of a minimally invasive approach.

Laparoscopic Management of Complicated Urachal Remnants / 전남의대학술지

Managing persistent and symptomatic urachal anomalies requires wide surgical excision of all anomalous tissue with a cuff of bladder tissue via the open approach. We report 7 cases with complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue. We expected that this technique would be less invasive and have lower morbidity. We report on the feasibility of this approach, including efficacy and outcomes. Eight patients with a mean age of 36.5 years who had symptomatic urachal diseases underwent laparoscopic excision between July 2004 and July 2012. With the use of four ports, the urachal remnant was dissected transperitoneally and then removed via the umbilicus port. The clinical results of laparoscopic urachal remnant excision as a minimally invasive surgery, the perioperative records, and pathologic results were evaluated. There were no intraoperative or postoperative complications. Mean surgery time was 2.7 hours. Mean hospital stay was 14.6 days. The patients with bladder cuff resection had a long admission and Foley catheterization period (mean, 14.4 and 11 days). Pathological evaluations were 6 cases of infected urachal cysts, 1 case of infected urachal sinus, and 1 case of urachal adenocarcinoma. We found no postoperative complications including any symptom recurrence or voiding difficulty during a mean follow-up of 46.3 months. The perioperative surgical outcomes achieved infection control and symptomatic relief and additionally good cosmesis. Complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue seems to be a safe, effective, and better cosmetic alternative with the advantages of a minimally invasive approach.

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.

Multislice spiral computer tomography imaging characteristics of urachus lesions / 中南大学学报(医学版)

OBJECTIVE@#To analyze the multislice spiral computer tomography (MSCT) manifestations and its value in the diagnosis of urachus lesions.@*METHODS@#A total of 26 patients with urachus disease diagnosed by pathological examination in our hospital between October 2007 and May 2011 were included in this study. We retrospectively analyzed MSCT images on the size, location, and shape character of the foci, and the image features of Retzius space.@*RESULTS@#In the group, 12 patients had simple urachal cyst with homogeneous fluid filling the cavity with thin wall in CT scanning; five had infected urachal cyst with thickened and enhanced wall, some patch and strip appearing in Retzius space surrounding the lesion; two had infected urachal sinus, and another 3 had urachus leakage. Four had urachal tumor showing irregular cysticsolid mass over the apex of the bladder with apparent enhancement in contrast imaging, and 2 had calcification. Invasion of the bladder wall was found in 4 patients, extensive invasion of the ileum, rectum, uterus and retroperitoneal lymph nodes was found in 1.@*CONCLUSION@#MSCT scan can demonstrate the location, shape, extent of the lesion as well as the relation with adjacent structures, thereby providing valuable information for the diagnosis and differential diagnosis of urachus lesions.

Use of Cystoscopic Tattooing in Laparoscopic Partial Cystectomy

PURPOSE: During laparoscopic partial cystectomy (LPC), lesion identification is essential to help to determine the appropriate bladder incisions required to maintain adequate resection margins. The inability to use tactile senses makes it difficult for surgeons to locate lesions during laparoscopic surgery. Endoscopic India ink marking techniques are often used in laparoscopic gastroenterological surgery. We present our experience with performing LPC with India ink during the surgical resection of various bladder lesions. MATERIALS AND METHODS: LPC with cystoscopic fine needle tattooing was performed on 10 patients at our institute. Tattooing was performed at 1- to 2-cm intervals approximately 1 cm away from the outer margin of the lesion with enough depth (the deep muscle layer) under cystoscopic guidance. LPC was performed by the transperitoneal approach. The clinical courses and pathologic results were analyzed. RESULTS: All LPC with cystoscopic tattooing cases were performed successfully. The mean patient age was 39.1 years. The mean operative time was 130.5 minutes, and the mean estimated blood loss was 93 ml. The mean hospital stay was 13.1 days, and the mean duration of indwelling Foley catheterization was 10.7 days. There were no significant intraoperative or postoperative complications except 1 case of delayed urinary leak and 1 case of delayed wound healing. The pathological diagnosis included 1 urachal cancer, 1 urachal remnant, 4 urachal cysts, 2 pheochromocytomas, and 2 inflammatory masses. All specimens showed adequate surgical margins. CONCLUSIONS: Cystoscopic tattooing in LPC is a simple and effective technique to assist in locating pathological bladder lesions intraoperatively. This technique can help to determine appropriate resection margins during LPC without incurring additional complicated procedures.

Urachal cyst presenting with huge abscess formation in adults / 대한외과학회지

Urachal disease, a disorder where embryonic remnant of the cloaca and the allantois present after birth as a midline fibrous cord, is usually detected in infancy and childhood. But urachal disease in adults is rare. We report a case of a huge abscess derived from a urachal cyst in an adult. A 52-year-old man presented with peri-umbilical distension and abdominal pain for 2 weeks. Ultrasonography and abdominal computed tomography scan demonstrated a huge abscess derived from the abdominal wall. After prompt incision and drainage, the remaining abscess cavity was removed completely under general anesthesia. Pathologic report was consistent with urachal duct cyst, and the patient was discharged in a week without complication.

Dilatação cística do úraco e uroperitônio em touros: relato de cinco casos / Cystic dilatation of the urachus and uroperitoneum in bulls: report of five cases

Descrevem-se os aspectos clínicos da dilatação cística do úraco e uroperitônio em cinco touros. Os animais apresentaram, em datas distintas, distensão abdominal e diminuição da ingestão de alimentos e água, até culminar com inapetência, cerca de duas semanas após o aparecimento dos primeiros sintomas. Ocorreu distensão abdominal bilateral progressiva, que, no início do processo, era discreta e restrita ao quadrante inferior do abdômen; com cerca de duas semanas de evolução, o abdômen assumiu forma arredondada semelhante à pera. Observou-se bruxismo, atonia ruminal e desidratação. A abdominocentese revelou a presença de líquido amarelado com concentração de ureia superior a 200mg/dL. A concentração de ureia no soro sanguíneo variou de 220 a 280mg/dL e a creatinina de 65 a 82mg/dL. A ligadura do divertículo do úraco próximo ao vértex da bexiga foi eficaz nos quatro touros operados.

The clinical findings and outcomes in five bulls with a perforation or rupture of the urachal diverticulum are described. All the bulls had a dilated round or pear-shaped abdomen, bruxism, ruminal atony, and dehidration. In all the bulls, abdominocentesis yielded a stream fluid and the serum concentrations of urea and creatinine were 220 to 280mg/dL and 65 to 82mg/dL, respectively. Peritoneal fluid concentration of urea was higher than 200mg/dL. In fours bulls, urachal diverticulums were closed next to the cranial pole of the bladders. After the surgery, the recovery was effective.

Laparoscopic Extraperitoneal Resection of Urachal Cyst

Remnant urachal cyst is a rare anomaly with an incidence of 1:5,000 and the majority are benign. The treatment of urachal cyst is complete surgical resection, and the cases of laparoscopic surgery for the resection have been reported since 1993. Most of the reports were about transabdominal laparoscopic approach, and it has been revealed that multiple skin incisions and trocar placements on upper abdomen were ineludible. With this condition, we are able to describe an extraperitoneal approach modified from total extraperitoneal herniorrhaphy, and to report a case of successful management of a urachal cyst by total extraperitoneal laparoscopic excision.

Initial Experience with Robotic-Assisted Laparoscopic Partial Cystectomy in Urachal Diseases

PURPOSE: In this study, we report our initial experience with robot-assisted laparoscopic partial cystectomy (RLPC) in urachal diseases. MATERIALS AND METHODS: Two men and two women with a mean age of 51.5+/-9.3 years underwent RLPC between June 2009 and December 2009. In each case, a single surgeon using the da Vinci-S robotic system (Intuitive Surgical, Sunnyvale, CA, USA) used a transperitoneal approach with a 0 degrees robotic camera. After careful observation of the intravesical portion of the mass, the mass was excised by use of monopolar scissors circumferentially. The bladder was closed in two layers with watertight running sutures made with 2-0 Vicryl. RESULTS: The mean operative time was 198 minutes (range, 130-260 minutes), the mean console time was 111 minutes (range, 70-150 minutes), and the mean estimated blood loss was 155 ml. The urethral catheter was removed on postoperative day 7 after a normal cystogram, and the surgical drain was removed on postoperative day 2.5 (range, 2-3 days). The mean hospital stay was 6 days (range, 4-7 days). There were no major complications. The pathology report revealed that one patient had a urachal cystadenoma, two patients had a urachal cyst, and one patient had a patent urachus. CONCLUSIONS: Our initial experience with RLPC for benign urachal disease is that it is a safe and feasible treatment modality. However, more cases are required to confirm the efficacy of RLPC.

Urachal Actinomycosis Mimicking a Urachal Tumor

A 26-year-old man presented with lower abdominal discomfort and a palpable mass in the right lower quadrant. An abdominal computed tomography (CT) scan revealed an abdominal wall mass that extended from the dome of the bladder. Fluorine-18 fluorodeoxyglucose (FDG) positron-emission tomography/CT (PET/CT) showed hypermetabolic wall thickening around the bladder dome area that extended to the abdominal wall and hypermetabolic mesenteric infiltration. Differential diagnosis included a urachal tumor with invasion into adjacent organs and chronic inflammatory disease. Partial cystectomy with abdominal wall mass excision was performed, and the final pathologic report was consistent with urachal actinomycosis.

Quiste gigante de uraco en el adulto / The giant cyst of urachus present in the adult patient

El quiste de uraco es una anomalía congénita que se incluye entre las lesiones originadas por la persistencia total o parcial de restos de este conducto. Se diagnostica principalmente durante la infancia y su complicación principal es la infección. Presentamos el caso de adulto con una tumoración abdominal gigante quística, diagnosticada como de origen uracal y tratada quirúrgicamente. Se hace una revisión del tema, con énfasis en los aspectos principales del tratamiento de la enfermedad(AU)

The urachus cyst is a congenital anomaly included among lesions originated by local or partial resistance of this duct. Is mainly diagnosed during infancy and its main complication is the infection. Authors present the case of an adult patient presenting with a cystic giant abdominal tumor, diagnosed as of urachal origin and treated by surgery. This matter is reviewed emphasizing on main features of disease treatment(AU)

A Case of Urachal Cyst Infection Occurring During Corticosteroids Therapy in a Patient with IgA Nephropathy

The urachus is a normal embryonic remnant of the primitive dome. It generally exists as a fibrous cord extending from the dome of the bladder to the umbilicus. Disorders of the urachus are developed as a result of its incomplete regression. The urachal cyst is the most common urachal anomaly, and is usually asymptomatic in infancy and childhood. However, when the cysts are large or accompanied with secondary infection, they may be detected in its early stage. A sonography or CT scan may be helpful to confirm the diagnosis of urachal cyst. The managements of infected urachal cyst are varied from simple drainage to radical excision. Here, we report an unusual case of urachal cyst infection that occurred during corticosteroids therapy in a girl with IgA nephropathy.

Urachal Xanthogranuloma: Laparoscopic Excision with Minimal Incision

Urachal xanthogranuloma is an extremely rare disease. A 23-year-old man presented with severe lower abdominal pain and voiding frequency. Computed tomography revealed a urachal mass with bladder invasion, which was suspected to be a urachal carcinoma or abscess. Laparoscopic urachal resection was performed with a minimal incision. Histopathologic examination identified the mass as a urachal xanthogranuloma.

Patología infantil en el paciente adulto / Children’s Pathology in the adult patient

El objetivo de este artículo es mostrar varias patologías que generalmente se hallan en el paciente pediátrico y son clasificadas como patologías infantiles por la edad en la que se presentan; sin embargo, éstas cursaron asintomáticas durante la infancia y aparecieron por primera vez en el paciente adulto. Creemos que su conocimiento es importante para que no se pasen por alto en el contexto de la radiología de los pacientes adultos y para su adecuada valoración por los métodos de imágenes diagnósticas. Se describen sus características clínicas y los hallazgos imaginológicos y se realizó una revisión de la literatura médica.