In our cohort, 60% of the IBD-U subjects remained as unclassified at 2 years; of those subsequently classified, a higher percentage followed a course more similar to UC. Most of the IBD-U subjects at diagnosis had serological and molecular signatures that are very similar to UC. Although the atypical presentations made the clinician to make an interim diagnosis of IBD-U, results of the molecular and serological factors performed at the time of diagnosis suggests that they were very similar to UC. However, long-term studies are needed to better understand the natural history and molecular characterization of pediatric onset IBD-U. 10.1093/ibd/izy136_video1Video 1.Video 1. Watch now at https://academic.oup.com/ibd/article-lookup/doi/10.1093/ibd/izy136izy136.video15791389938001.

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An unusual finding in an adult patient with an infected urachal cyst, was treated surgically using the Da Vinci robot. A 26-year-old woman was admitted to our hospital with complaints of lower abdominal pain and burning sensation with urination. She was diagnosed with lower urinary tract infection, treatment did not help her symptoms and further evaluation of CT revealed complex enhancing mass superior to the urinary bladder. The differentials included inflammatory cause such as an abscess, neoplastic mass, urachal cyst, vitello intestinal fistula and urachal sinus. Da Vinchi robotic diagnostic laparoscopy was performed to obtain an accurate assessment and treatment. After cystoscopy followed by laparoscopic exploration of the abdominal and pelvic cavity further helped to narrow down a diagnosis of remnants of urachus. Pathology of the excised specimen showed inflammation without evidence of malignancy and confirmed Urachal cyst. The patient had an uneventful post-operative course.

Interferon-gamma Release Assays forTuberculosis Screening in Pediatric Inflammatory Bowel DiseaseT o the Editor: We read the publication on ''Performance of Interferon-Gamma Release Assay (IGRA)s for Tuberculosis Screening in Pediatric Inflammatory Bowel Disease'' with great interest (1). Stevens et al noted that ''IGRA's are a useful tool to screen for LTBI, both prior to anti-TNF therapy and during treatment (1).'' The important consideration is on the diagnostic performance of the IGRA. The high false-positive rate might be an important problem that limits the usefulness of IGRA. In addition, the cost of IGRA test should be considered. Indeed, the simple test, such as tuberculin skin test could give the similar diagnostic performance for tuberculosis detection among patient with inflammatory bowel disease (2,3).