Year 2021 Vol. 29 No 4

CASE REPORTS

V.S. ZHUKOVSKIY, M.V. PANKIV, V.V. CHAPLYK, V.S. KOZOPAS, V.V. HUMENIUK

INFECTED URACHAL CYST IN AN ADULT

Danylo Halytskyy Lviv National Medical University, Lviv,
Ukraine

Urachus is a tubular formation originating from the top of the urinary bladder and directed to the umbilicus between the peritoneum and the transverse fascia of the abdomen. In an embryo, it serves to divert primary urine to the amniotic fluid. In case, if obliteration of the duct does not occur until the birth, various pathological processes can develop in it. The most common abnomalies of urachus reported in adults are an infected urachal cyst and urachal carcinoma. These diagnoses are not always easy to make due to atypical symptoms of their manifestation and the rarity of these diseases – just two cases per 100,000 hospitalizations of adults. A 22-year-old man with a subcutaneous abscess and an external fistula located in the umbilical region with redness of the surrounding skin. 16 hours after dissection and drainaging of the abscess, the patient’s condition worsened, pain in the lower parts of the abdomen began, muscle tension of the anterior abdominal wall and inflammatory changes in blood tests were revealed. The patient was operated on for peritonitis. A two-chambered urachus cyst of the «hourglass» type, with the formation of a dense consistency calculus in one of the cavities, which perforated into the abdominal cavity This clinical case is of the great interest from the point of view of the atypical course and the treatment of a rather rare anomaly in adults. The publication will remind emergency medicine physicians about the possibility of infected urachus in patients with symptoms of acute abdomen.

Keywords: infected urachal cyst in an adult, complications, acute abdomen, diagnosis, surgical management
p. 504-509 of the original issue
References
  1. Mahato NK, Mittal MM, Aggarwal R, Munjal KM. Encysted urachal abscess associated with a premalignant lesion in an adult male. Urotoday Int J. 2010 Oct;3(5). doi: 10.3834/uij.1944-5784.2010.10.01
  2. Ueno T, Hashimoto H, Yokoyama H, Ito M, Kouda K, Kanamaru H. Urachal anomalies: ultrasonography and management. J Pediatr Surg. 2003 Aug;38(8):1203-7. doi: 10.1016/s0022-3468(03)00268-9
  3. Ward TT, Saltzman E, Chiang S. Infected urachal remnants in the adult: case report and review. Clin Infect Dis. 1993 Jan;16(1):26-29. doi: 10.1093/clinids/16.1.26
  4. Spataro RF, Davis RS, McLachlan MS, Linke CA, Barbaric ZL. Urachal abnormalities in the adult. Radiology. 1983 Dec;149(3):659-63. doi: 10.1148/radiology.149.3.6647841
  5. Yiee JH, Garcia N, Baker LA, Barber R, Snodgrass WT, Wilcox DT. A diagnostic algorithm for urachal anomalies. J Pediatr Urol. 2007 Dec;3(6):500-4. doi: 10.1016/j.jpurol.2007.07.010
  6. Musko N, Dobruch J, Piotrowicz S, Szostek P, Borówka A. Infected urachal cyst in a young adult. Cent European J Urol. 2014;67(2):199-201. doi: 10.5173/ceju.2014.02.art19
  7. Lucerna A, Lee J, Espinosa J, Hertz R, Scali V. An Adult with a Remnant Urachus Anomaly Diagnosed in the Emergency Department. Case Rep Emerg Med. 2018 Aug 14;2018:6051871. doi: 10.1155/2018/6051871. eCollection 2018.
  8. Tazi F, Ahsaini M, Khalouk A, Mellas S, Stuurman-Wieringa RE, Elfassi MJ, Farih MH. Abscess of urachal remnants presenting with acute abdomen: a case series. J Med Case Rep. 2012 Jul 30;6:226. doi: 10.1186/1752-1947-6-226
  9. Gusev AA, Yacyk SP, Kirgizov 1V, Dyakonova EYu, Karpachev SA, Ryazanov MV. Urachus pathology: literature review, modern aspects of the surgical manual and own clinical experience of laparoscopic treatment. Pediatriia (Pril Consilium Medicum). 2018;(3):80-84. doi: 10.26442/2413-8460_2018.3.80-84 (In Russ.)
  10. Ashley RA, Inman BA, Routh JC, Rohlinger AL, Husmann DA, Kramer SA. Urachal anomalies: a longitudinal study of urachal remnants in children and adults. J Urol. 2007 Oct;178(4 Pt 2):1615-18. doi: 10.1016/j.juro.2007.03.194
  11. Yoo KH, Lee SJ, Chang SG. Treatment of infected urachal cysts. Yonsei Med J. 2006 Jun 30;47(3):423-27. doi: 10.3349/ymj.2006.47.3.423
  12. Ekwueme KC, Parr NJ. Infected urachal cyst in an adult: a case report and review of the literature. Cases J. 2009 Jun 25;2:6422. doi: 10.4076/1757-1626-2-6422
  13. Gami BL, Biswas S. An infected urachal cyst. BMJ Case Rep. 2013. doi: 10.1136/bcr-2012-007105.
  14. Kwok C.M. Infected urachal cyst in an adult: a laparoscopic approach. Case Rep Gastroenterol. 2016 May-Aug;10(2):269-74. Published online 2016 Jun 14. doi: 10.1159/000446642
  15. Dickhoff C, Campo MM, Ophof PJ, Makkus AF, Tan KG, Plaisier PW. Urachus fistula: a rare first presentation of diverticulitis. Case Rep Gastroenterol. 2008 Sep 20;2(3):287-90. doi: 10.1159/000151580
  16. Hsu CC, Liu YP, Lien WC, Lai TI, Chen WJ, Wang HP. Urachal abscess: a cause of adult abdominal pain that cannot be ignored. Am J Emerg Med. 2005 Mar;23(2):229-30. doi: 10.1016/j.ajem.2004.03.012
  17. Agatstein EH, Stabile BE. Peritonitis due to intraperitoneal perforation of infected urachal cysts. Arch Surg. 1984 Nov;119(11):1269-73. doi: 10.1001/archsurg.1984.01390230041009
  18. Diehl K. A rare case of urachal calculus. Br J Urol. 1991 Mar;67(3):327-28. doi: 10.1111/j.1464-410x.1991.tb15147.x
  19. Wan YL, Lee TY, Tsai CC, Chen SM, Chou FF. The role of sonography in the diagnosis and management of urachal abscesses. J Clin Ultrasound. 1991 May;19(4):203-8. doi: 10.1002/jcu.1870190403
  20. Zafar S, Shah R, Dinneen M, Davies C. Imaging of Urachal remnant diseases. Congress: ECR 2019. Poster Number:C-2770. doi: 10.26044/ecr2019/C-2770
  21. Allen JW, Song J, Velcek FT. Acute presentation of infected urachal cysts: case report and review of diagnosis and therapeutic interventions. Pediatr Emerg Care. 2004 Feb;20(2):108-11. doi: 10.1097/01.pec.0000113880.10140.19
  22. Castillo OA, Vitagliano G, Olivares R, Sanchez-Salas R. Complete excision of urachal cyst by laparoscopic means: a new approach to an uncommon disorder. Arch Esp Urol. 2007 Jun;60(5):607-11. doi: 10.4321/s0004-06142007000500020
  23. Elkbuli A, Kinslow K, Ehrhardt JD Jr, Hai S, McKenney M, Boneva D. Surgical management for an infected urachal cyst in an adult: Case report and literature review. Int J Surg Case Rep. 2019;57:130-33. doi: 10.1016/j.ijscr.2019.03.041
  24. Mesrobian HG, Zacharias A, Balcom AH, Cohen RD. Ten years of experience with isolated urachal anomalies in children. J Urol. 1997 Sep;158(3 Pt 2):1316-8. doi: 10.1097/00005392-199709000-00173
  25. Yu JS, Kim KW, Lee HJ, Lee YJ, Yoon CS, Kim MJ. Urachal remnant diseases: spectrum of CT and US findings. Radiographics. 2001 Mar-Apr;21(2):451-61. doi: 10.1148/radiographics.21.2.g01mr02451
  26. Kwok CM. Infected urachal cyst in an adult: a laparoscopic approach. Case Rep Gastroenterol. 2016 Jun 14;10(2):269-74. doi: 10.1159/000446642. eCollection 2016 May-Aug.
  27. Chiarenza SF, Bleve C. Laparoscopic management of urachal cysts. Transl Pediatr. 2016 Oct;5(4):275-81. doi: 10.21037/tp.2016.09.10
  28. Passoni S, Guerra A, Marengo M. Laparoscopic treatment of an infected urachalcyst and diverticulum in a young adult: Presentation of a case and review of the literature. Int J Surg Case Rep. 2018;49:87-90. doi: 10.1016/j.ijscr.2018.06.018
Address for correspondence:
79010, Ukraine, Lviv, Pekarskaya Str. 69,
Danylo Halytskyy Lviv National Medical University, the Department of Emergency Medicine
and Military Medicine
tel. mobile: +38 067 725 32 39,
e-mail: zukovskiy@ukr.net,
Zhukovskiy Vladimir S.
Information about the authors:
Zhukovskiy Vladimir S., PhD, Associate Professor of the Department of Emergency Medicine and Military Medicine, Danylo Halytskyy Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/ 0000-0002-0594-5316
Pankiv Maryana V., PhD, Post-Graduate Student, of the Anatomy Department , Danylo Halytskyy Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/ 0000-0002-3714-2577
Chaplyk Viktor V., PhD, Associate Professor, Head of the Depatment of Emergency Medicine and Military Medicine, Danylo Halytskyy Lviv National Medical University, Lviv , Ukraine.
https://orcid.org/0000-0002-1633-0712
Kozopas Viktor S., PhD, Associate Professor of the Department of Emergency Medicine and Military Medicine, Danylo Halytskyy Lviv National Medical University, Lviv , Ukraine.
http://orcid.org/0000-0003-3451-6016
Humeniuk Vasiliy V., PhD(Ped.), Associate Professor of the Department of Emergency Medicine and Military Medicine, Danylo Halytskyy Lviv National Medical University, Lviv , Ukraine.
https://orcid.org/0000-0003-2736-3875
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