Urachal remnants: from embryology to clinical practice.

The urachus is a tubular structure that is apparent on the third week and connects the ventral cloaca to the yolk sac, as a progression from the allantois. Following the normal regression procedure, the urachus remains as the median umbilical ligament. Urachal remnants are present in 1.03% of paediatric patients while in 92.5% of cases represent incidental findings. Urachal anomalies are classified in four types as patent urachus (50-52%), urachal sinus (15%), urachal cyst (30%) and urachal diverticulum (3-5%). Ultrasound scan is the most commonly performed diagnostic imaging study. In case of symptomatic urachal remnants, surgical excision is indicated. Asymptomatic urachal remnants that are diagnosed at the neonatal period or early infancy should be watched up to 6 months of age, as they are likely to resolve. In persistent or symptomatic urachal remnants there is a risk of inflammation or even malignancy development, therefore we believe that there is indication for preventive surgical excision that may be performed either open or laparoscopically or by robot-assisted laparoscopy.

A rare case of infected urachal cyst leading to intestinal obstruction in a 3-month-old boy with febrile urinary tract infection: Case report.

RATIONALE: Urachal anomalies are rare and can present with various clinical manifestations. Urachal remnants, in particular, can be difficult to diagnose because of atypical symptoms at presentation. This study reports a case of intestinal obstruction in an infant secondary to an infected urachal cyst. PATIENTS CONCERNS: A 3-month-old boy with a known febrile urinary tract infection developed acute abdominal distension. DIAGNOSES: Abdominal ultrasound (US) and computed tomography (CT) revealed a nonspecific, ill-defined soft tissue density at the mid-abdomen, associated with intestinal obstruction. INTERVENTIONS: Emergency exploratory laparotomy was performed. The site of the obstruction was found to be at the mid-small bowel; the proximal small bowel was markedly distended, and the small bowel and sigmoid colon were adherent to urachal remnant. The urachal remnant was excised, and the peritoneal adhesions were lysed. OUTCOMES: The day after surgery, the patient was discharged without any complications. LESSONS: Intestinal obstruction is an exceedingly rare presentation of urachal remnants. This case highlights that urachal anomalies should be considered in the differential diagnosis in patients with intestinal obstruction and a concurrent febrile urinary tract infection.

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.

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)

Complete excision of urachal cyst by laparoscopic means: a new approach to an uncommon disorder / Escisión completa de quiste de uraco por vía laparoscópica: un nuevo abordaje para un trastorno poco frecuente

Objetive: Anomalies of the urachal remnant are rare. Urachal cysts are usually asymptomatic, however, when they become infected, they can mimic a wide variety of intra-abdominal pathologies. We present two patients in which an urachal cyst was found. Methods: Two male patients 25 and 38 years old respectively underwent laparoscopic resection of an urachal remnant. In one of the cases the urachal remnant was complicated by infection. Opportune clinical and radiologic diagnose was made in both cases and complete excision of the urachal remnant was carried out by laparoscopic means. Results: The procedures were performed without complications and follow up showed excellent results. Both patients presented very short convalescence with rapid recovery. Conclusions: The treatment of choice for urachal pathology is the complete excision of the complicated lesion. For this matter laparoscopic surgery assures surgical results comparable to conventional surgery adding the advantages of a minimally invasive approach (AU)

Las anomalías del remanente de uraco son raras. Los quistes de uraco son generalmente asintomáticos; sin embargo, cuando se infectan, pueden imitar una amplia variedad de patologías intraabdominales. Presentamos dos pacientes con quiste de uraco. Métodos: Dos pacientes varones de 25 y 38 años, respectivamente, fueron sometidos a resección laparoscópica de remanentes de uraco. En uno de los casos el remanente de uraco se había complicado con infección. En ambos casos se hizo el diagnóstico clínico y radiológico adecuado y se llevó a cabo escisión completa del remanente de uraco por vía laparoscópica. Resultados: Las operaciones se realizaron sin complicaciones y el seguimiento mostró unos resultados excelentes. Ambos pacientes tuvieron una convalecencia muy corta, con una rápida recuperación. Conclusiones: El tratamiento de elección de la patología de uraco es la escisión completa de la lesión complicada. La cirugía laparoscópica asegura unos resultados quirúrgicos comparables con la cirugía convencional, añadiendo las ventajas del abordaje mínimamente invasivo (AU)

Urachal Anomalies in Children: A Single Center Experience

The objective of this study is to define optimal diagnosis and treatment strategies for patients with urachal anomalies in the pediatric age group. The medical records of 21 children who had undergone surgery for urachal anomalies at Severance Hospital, Yonsei University College of Medicine from January 1990 to April 2005 were reviewed. The subjects included 14 males and 7 females (M:F 2:1). The four types of urachal anomalies confirmed were a urachal cyst in 10 patients (47.6%), a patent urachus in 6 (28.6%), a urachal sinus in 4 (19.0%) and a urachal diverticulum in 1 (4.8%) patient. The most common presenting complaint was umbilical discharge (n = 10, 40.0%), followed by abdominal mass (n = 9, 36.0%). Urachal anomalies were diagnosed by ultrasonography in 18 patients, and 7 of them were additionally examined by computed tomography. The remaining patients were diagnosed solely by surgical exploration. Excision was performed in all patients and was supplemented by partial cystectomy in three. Umbilical discharge was the most common clinical manifestation in our patients, suggesting that ultrasonography should be performed in patients with umbilical discharge to differentiate urachal anomalies. We found the most common anomaly to be the urachal cyst, and all patients were successfully treated by surgical excision.

Retención aguda de orina, “RAO“, como presentación de quiste de uraco / Urachal cyst presentated as acute urinary retention

El quiste de uraco esta presente aproximadamente en el 2% de los adultos, siendo su diagnostico difícil y secundario a las manifestaciones de su complicaciones. Presentamos un caso inusual de retención aguda de orina en un quiste de uraco, que debutó como dolor hipogástrico y anuria (AU)

About 2% of adults have an urachal cyst. The diagnosis is usually made due to its clinical complications. We report an inusual case of acute urinary retention due to an urachal cyst, with hipogastric pain and anuria as initial syntoms (AU)

Quiste de uraco sobreinfectado como diagnóstico diferencial poco frecuente de apendicitis aguda / Infected urachal cyst as an unusual differential diagnosis of acute appendicitis

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Quiste de uraco: diagnóstico diferencial con hidrosálpinx / Urachal cyst: differential diagnosis with hydrosalpinx

Revisar el diagnóstico diferencial de los quistes pélvico-abdominales con el quiste de uraco, y su excisión laparoscópica. Mujer de 23 años, que presenta como hallazgo casual una masa quística pélvica de 85 x25 mm tras una ecografía. La resonancia magnética (RM) informa de un posible hidrosálpinx. Un mes después, comienza con dolor abdominal y se indica laparoscopia. El diagnóstico final fue quiste de uraco. La patología del quiste de uraco suele ser asintomática. La complicación más frecuente es la infección. La ecografía y la RM son pruebas de elección para su diagnóstico. La laparoscopia es una técnica válida para su tratamiento

To review the differential diagnosis between abdominopelvic cysts and urachal cyst and the laparoscopic treatment of this entity. A 23-year-old woman presented a 85 x 25 mm pelvic cyst as an incidental finding on ultrasound examination. Magnetic resonance imaging (MRI) revealed a possible hydrosalpinx. On month later, the patient started complaining of abdominal pain and laparoscopy was indicated. Diagnosis was urachal cyst. Urachal disease tends to be asymptomatic. The most common complication is infection. The diagnostic tests of choice are ultrasound and MRI. Laparoscopy is a useful technique in the treatment of this entity (AU)

Patología umbilical / Umbilical pathology

La patología umbilical es muy frecuente durantela edad pediátrica. En este artículo se revisa toda lapatología que puede aparecer a nivel umbilical, preferentementede origen congénito o adquirido. Serevisa el onfalocele, la patología por conducto onfalomesenterico,la persistencia de uraco, así comolas hernias umbilicales, supraumbilicales y las herniasepigástricas, haciendo especial hincapié en losaspectos diagnósticos y terapéuticos

The umbilical pathology is frequent during childhood.This paper reviews the pathology that couldappear to umbilical level of congenital or acquiredorigin. Diagnostic and therapeutic aspects of omphalocele,omphalomesenteric duct and sinus, urachus,umbilical hernias, midline and epigastric herniasare revised

Seio uracal em adulto / Urachal sinus in adult

Os autores apresentam um caso de seio uracal em adulto, patologia rara nesta faixa etária, e revisam os aspectos embriológicos e anatômicos do úraco, evidenciando sua apresentaçao clínica, evoluçao e terapêutica.

Anomalías del uraco relacionadas a transtornos umbilicales

Se reúnen 12 pacientes con patología de Uraco ingresados al Departamento de Cirugía Pediátrica del Hospital Materno Infantil `San Bartolomé' entre los años 1964 a 1973 (15 años). Se revisan aspectos embriológicos, anatómicos, sintomáticos, diagnósticos, complicaciones y tratamiento para cada una de las alteraciones, así como su incidencia en relación al sexo y la edad. De los pacientes estudiados 6 fueron Senos Uracales, 5 Uracos Permeables y Quiste Uracal. La edad más frecuente para el inicio de los síntomas y signos fue entre el nacimiento y los seis primeros meses de vida. Predominó el sexo masculino. De los exámenes auxiliares, el que presta mayor ayuda es la fistulografía con sustancias de contraste practicada a través del ombligo y que dibuja un trayecto ciego o rellena la vejiga. Se comprueba que el tratamiento de elección es quirúrgico y que la mortalidad es baja.

Quiste y tumor del uraco en un mismo paciente / Urachus cyts and tumor in the same patients

Se presenta un paciente masculino de 18 años en el que coincidían dos afecciones tumorales relacionadas con la persistencia del uraco: un quiste y un adenocarcinoma mucoproductor. Justifican su publicación la poca frecuencia de ambas afecciones y la coincidencia en un mismo paciente, así como el hecho de no haber encontrado otro caso similar en la literatura revisada

Quiste del uraco infectado. Apropósito de un caso / Infected urachal cyst. Report of a case

Se presenta el caso de un paciente que presenta tumofacción de pared abdominal de localización umbilicalcon una evolución de 4 semanas y presencia de derrame parcial mínimo seropurilento del mismo en las últimas tres semanas acompañado de alteraciones imflamatorias de la piel y que aparentemente no estaba condicionado por una alteración o infección intraperitoneal.

Quiste infectado del uraco en un niño con dolor abdominal agudo

Presentación de un caso de quiste del uraco infectado, y discusión de su apariencia imaginológica

Abscesso gigante do remanescente uracal / Large abcess of urachal remnant

Os autores descrevem um caso de abscesso de grandes proporcoes do remanescente urucal em um individuo idoso. O diagnostico definitivo so foi possivel atraves do estudo histologico da peca operatoria. E enfatizada a dificuldade no diagnostico diferencial das massas de hipogastrio, lembrando a possibilidade da presenca, mesmo que rara, de remanescente urucal infectado

Úraco persistente: relato de caso / Persistent urachus: case report

O úraco é uma estrutura fetal que conecta a bexiga à cicatriz umbilical, persistindo em raras ocasiões. Os poretadores esta entidade podem, ocasionalmente, apresentar sintomas. A persistência do úraco pode ser classificada em congênita ou adquirida. Nesta fecha normalmente, podendo recanalizar após o nascimento, e constitui um dos cinco tipos de anormalidades do úraco: úradco persistente, seio umbilical de úraco, divertículo vésico-uracal, cisto de úraco e seios alternantes de úraco. Os sintomas podem variar com o tipo de alteração encontrada ou a presença de infecção concomitante. Métodos de imagem podem ser úteis e o tratamento depende do tipo ed doença que envolve o úraco persistente. Com o objetivo de relatar a ocorrência de úraco persistente em uma paciente adulta, ressaltando a importância diagnóstica, descreve-se o caso de uma mulher de 28 anos com abaulamento na região umbilical, de consistência fibro-elástica, indolor à palpação. O exame ultrassonográfico detectou cisto subumbilical. Foi submetida a tratamento cirúrgico com evidência de cisto vesical. A paciente evoluiu sem intercorrências no pós-operatório. O exame histopatológico foi compatível com um cordão fibro-muscular com camada interna de epitélio transicional, camada média de tecido conectivo e camada externa muscular, sendo o cisto epidérmico