1/83. A case of urachal remnant presenting as acute abdominal pain. A 30-year-old male presented to the Emergency Department, over sequential visits, with abdominal complaints. The patient's presenting history and physical examination were mistakenly diagnosed variously as gastroenteritis, omphalitis, and appendicitis. Ultimately, the diagnosis of urachal fistula was made at surgery. This case is discussed in light of prior published experiences with this disease entity. ( info) |
2/83. urachal cyst associated with a suprapubic sinus. Urachal anomalies are frequent and may exhibit many anatomical variations. We report a case of a urachal cyst that had a sinus tract extending to the lower abdomen just above the pubic symphysis. Histologic examination of the specimens showed a squamous-epithelium-lined sinus tract and a columnar-epithelium-lined cyst, which suggested a developmental disorder. This may be an extremely rare case where the urachal cyst opened into the suprapubic sinus. ( info) |
| BACKGROUND: We report on an extremely rare case of urachal tuberculosis that was confirmed using a polymerase chain reaction test of paraffin-embedded material. methods/RESULTS: A 62-year-old man presented with pollakiuria. With a diagnosis of urachal abscess, the patient underwent en bloc resection of the cystic mass. A bacterial culture test of the content showed no organism. The histopathologic findings suggested urachal tuberculosis. The AMPLICOR polymerase chain reaction test by using paraffin-embedded sections revealed the existence of mycobacterium tuberculosis in the resected tissue. The only positive finding in systemic screening examinations for tuberculosis was old tuberculosis scars in the upper right lung. It was supposed that hematogeneous spreading from the lung lesion may result in urachal tuberculosis after a long latent period. CONCLUSIONS: Although urachal tuberculosis is an extremely rare condition, tuberculosis must always be kept in mind when observing any infectious diseases. ( info) |
| Urachal abscess is an uncommon condition with protean features and often presents a diagnostic challenge to clinicians. This case report describes a 41-year-old woman with severe multiple sclerosis who was referred to a gynaecological oncology service with the presumed diagnosis of advanced ovarian cancer. A diagnosis of urachal abscess and infected bladder diverticulum was made by a combination of imaging modalities and a percutaneous biopsy. It is important to be aware of this entity, as the presentation varies widely and when diagnosed early the condition may be treated appropriately by relatively minor surgical intervention. ( info) |
5/83. Laparoscopic-assisted removal of a large urachal cyst. A 48-year-old woman was seen because of an abdominal tumor. laparoscopy was performed for diagnosis and treatment. A large cystic mass was hanging from the anterior abdominal wall and was removed with laparoscopic assistance. Histologic examination revealed a urachal cyst. (J Am Assoc Gynecol Laparosc 8(1):159-160, 2001) ( info) |
6/83. Primary actinomycosis mimicking urachal carcinoma. We report a case of urachal actinomycosis that presented with a progressively enlarging infraumbilical mass associated with umbilical discharge. Computed tomography revealed an extraperitoneal mass involving the dome of the bladder. The possible diagnosis included a malignant urachal neoplasm or chronic inflammatory mass. Partial cystectomy and excision of the mass was performed. The pathologic examination revealed actinomycosis. The patient was treated with a 6-month course of antibiotics. No recurrence was noted 1 year postoperatively. ( info) |
7/83. A study of the anatomic features of the duct of the urachus. The urachus is an embryonic remnant resulting from involution of the allantoic duct and the ventral cloaca. Attaching the bladder dome to the umbilicus, this duct becomes progressively obliterated during fetal life. It may subsequently persist as different variants after birth, some regarded as normal, others as pathologic, due to incomplete closure. Six pediatric cases are reported here, and the literature on the embryology and anatomic basis of the duct is discussed. The urachus is present in nearly 100% of children at birth, with several possible shapes: tubular, fusiform or funnel. It gradually regresses and is found in only a third of adults. Its length varies from 1 to 15 cm. In our series 6 patients showed defective closure of the duct, including 3 with complete patency, 1 cyst, 1 diverticulum and 1 external sinus. Although rare, congenital pathology of the urachus requires a sound knowledge of the anatomy and embryology to distinguish normal forms from those subject to complications. It should be suspected with any lesion in the umbilical region and the appropriate treatment instituted. ( info) |
| The urachus is an embryonic structure that persists after birth in some individuals and can cause various problems. We report a case of an inflamed urachal cyst filled with a thick yellow fluid and several calculi in a woman with a 1-month history of dysuria. physical examination revealed a fist-sized tumor located infraumbically in the midline. The patient's erythrocyte sedimentation rate was elevated; the results of all other routine laboratory studies were normal. Sonography showed a regularly shaped, ovoid, hypoechoic cystic area in the abdominal wall measuring 8 x 4 x 3 cm and containing several hyperechoic masses associated with acoustic shadowing. The wall of the cyst was inhomogeneous, and a thin hypoechoic linear tract linked the superior aspect of the mass to the umbilicus. The results of excretory urography, voiding cystography, and cystoscopy excluded an abnormality of the urinary system. A urachal cyst was diagnosed, and the mass was surgically removed. The surgical specimen was sent for histopathologic analysis, which confirmed the diagnosis. ( info) |
| Urachal anomalies are uncommon defects arising either by incomplete obliteration of the urachus during the foetal period or by its reopening after postnatal regression. Five anomalies have been described: congenital patent urachus, urachal cyst, umbilical-urachal sinus, vesico-urachal diverticulum, and alternating sinus. Only congenital patent urachus is present at childbirth. The other forms are usually acquired disorders. Nevertheless, they commonly appear in children, being less common in the adult. colic-urachal fistulas are quite uncommon findings. Only three cases have been reported thus far. The aim of this study is to report the fourth case of sigmoid-urachal fistula, and the first one appearing without an urachal cyst. ( info) |
| A 54 year old man presented with a six month history of abdominal pain. A computerised tomography scan showed a well defined intra-abdominal unilocular mass with a calcified wall just superior to the bladder. At laparotomy, pseudomyxoma peritonei was discovered, together with a midline abdominal mass adherent to the anterior abdominal wall originating from the fundus of the bladder. The specimen consisted of a cystic mass measuring 14 x 9.5 x 7 cm overall, which contained mucoid material. Histological examination revealed that the cyst was lined by mucinous epithelium, which in areas varied from having bland morphology to showing pronounced nuclear and architectural atypia. There was abundant extracellular mucin. The specimen was extensively sampled but there was no evidence of invasion. This tumour has many unusual features, namely: the absence of destructive invasion, association with pseudomyxoma peritonei, areas of dysplasia and cystadenoma, and stromal osseous metaplasia within the wall. ( info) |