Urachal cyst presenting with huge abscess formation in adults

Abstract

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.

Urachal Sinus Complicated by an Umbilical Abscess

“…A perusal and evaluation of the published medical literature reveals that cases of infected urachal sinuses can manifest with a vague constellation of clinical symptoms, including umbilical discharge, erythema, lower abdominal pain, fever, and burning micturition [6,7]. In a multitude of instances, a urachal sinus can be secondarily infected, usually with Escherichia coli, and form an abscess, thereby leading to abdominal pain and a purulent umbilical discharge [8].…”

“…A multitude of studies purport the notion that multimodal imaging techniques remain pivotal in aptly construing a diagnosis of an infected urachal sinus in the adult population [4,7]. Although they are seldom encountered in adults, urachal sinuses ought to be considered in the list of differential diagnosis pertaining to adult male patients presenting with lower abdominal pain and intermittent umbilical discharge.…”

“…The differential diagnosis, in such instances, usually consists of pathologies such as a UPS and omphalitis. While prompt treatment can effectively resolve the pathology, a dilatory diagnosis can result in adverse outcomes such as the development of fistulas and systemic sepsis [2,7].…”

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

“…The urachus is a normal embryological tract remnant of the cloaca and allantosis and a midline fibrous cord extending from the urinary bladder to the umbilicus [ 1 ]. It occupies the potential midline space between the peritoneum and transversalis abdominis fascia.…”

“…Four types have been classified: patent urachus (about 50%), which connects the bladder and umbilicus; urachal cyst (about 30%), which is a cyst-like structure within the urachus; umbilical sinus (about 15%), in which the urachus opens into the umbilicus only; and vesicourachal diverticulum (about 5%), in which the urachus has a wide patent opening into the bladder [ 2 ]. Congenital urachal anomalies are more common in males, at a ratio of 2:1 to 9:1 and should be suspected if umbilical discharge exists in the urine during infancy and childhood [ 1 ]. Our patient was a middle-aged woman with an infected urachal cyst that progressed to an abscess.…”