Remnants of urachus in infants and children —The problems of diagnosis and treatment—

A total 17 cases of remnants of urachus were examined between 1981 and 1989, including 2 cases of patent urachus, 5 of urachal cyst, 9 of urachal sinus, and 1 of urachal diverticulum. A long urachal sinus was considered to be caused by the self-destruction of a cyst. While patent urachus was diagnosed in neonates with urine discharge from the umbilicus, cysts or sinuses accompanied by infection were more often found in older children. Imaging of the burrows was diagnostic in 8 out of 11 cases, ultrasound examination in 9 out of 12, and CT examination in all of 3 cases. Since this condition is frequently accompanied by malformations of the urinary system, attention must be paid to locating the accompanying anomalies. Although primary extraction was performed in 13 cases, the primary treatment of cases with highly infected cysts should be drainage, followed by secondary extraction. Furthermore, caution must be exercised to avoid hemorrhage in cases with dilation of the umbilical artery.     

Allantoic remnants presenting as a giant retroperitoneal cyst

Urachal anomalies are usually found in early childhood or just after birth. These usually involve patent ductus urachus, urachal cyst, umbilical-urachal sinus or vesicourachal diverticulum. Very rarely are urachal anomalies found in adults, usully as an infected urachal cyst. We are presenting a case of surgically removed giant urachal retroperitoneal cyst that was found by chance during the abdominal ultrasound examination of a 22 year old man who was initially treated for idiopathic hypertension.     

脐尿管占位性病变的CT诊断及鉴别诊断

目的 探讨CT检查在诊断和鉴别诊断脐尿管占位性病变方面的价值。方法根据临床病理证实的24例脐尿管占位性病变患者的CT影像学特征，分析其大小、部位、形态、性质、Retzius间隙影像学变化及增强后的影像学特征。结果 24例均明确诊断。4例为脐疝，其中3例疝囊内容物为网膜组织，另1例为肠管。20例为脐尿管占位性病变，均位于Retzius间隙内的脐尿管行走区，其中单纯性脐尿管囊肿6例，CT表现为长条椭圆形完整囊状包块，囊壁薄、光滑，囊内容物呈均匀低密度回声，增强后无强化；感染性脐尿管囊肿7例，CT表现为内部回声不均，灶周Retzius间隙内可见絮状或条索状密度增高影，其中4例囊壁明显增厚，3例囊壁不完整，2例呈多房性囊肿；脐尿管憩室伴结石3例，CT表现为中线处膀胱壁内可见高密度结石影；脐尿管肿瘤性病变4例，均于膀胱顶壁区中线处发现不规则软组织肿块影，增强后明显强化。结论 脐尿管占位性病变并不常见，多为感染性囊肿，结合临床术前确诊并不困难。CT是脐尿管占位性病变术前明确诊断和鉴别诊断的重要措施之一。     

Staged approach to the urachal cyst with infected omphalitis

Embryonal urachus exists as a cord-like structure between the urinary bladder and the umbilicus. In some cases of urachal cysts at the level of the navel, no special symptoms are detected during childhood, but spontaneous drainage at the navel may occur after adolescence, which is called an infected urachal cyst. Especially in cases accompanied by infected omphalitis, no constant opinion has been established to choose either initially curative resection or staged incision. In this study, we evaluated the characteristics of patients with urachal cysts who underwent the staged approach. Twenty patients (14 men and 6 women) with urachal cysts complicated by infected omphalitis were treated in our hospital. Staged surgery was performed for 18 patients. Neither recurrent omphalitis nor subsequent urachal carcinoma was observed. It is desirable that urachal cyst accompanied by intractable omphalitis should be treated by conservative therapy, conducted image diagnosis, and chosen staged surgery.     

脐尿管未闭异位开口的诊断治疗(附2例报告)

目的:探讨先天性脐尿管未闭异位开口的诊断与治疗方法。　方法:对2例有阴茎背侧溢液史5～6年的 患者进行瘘口探针探查、亚甲蓝注射试验、膀胱镜、B超等辅助检查方法诊断脐尿管未闭异常,予手术切除所有病变 组织及脐尿管。　结果:2例经手术及病理检查均证实为脐尿管交流囊瘘,患者术后随访至今无复发及癌变。　结 论:瘘口探针探查、亚甲蓝注射试验、B超检查为有效的诊断措施;手术应尽可能彻底切除脐尿管及其异常组织。     

先天性脐尿管异常疾病的诊治体会（附9例报告）

目的：探讨先天性脐尿管异常疾病的诊断与治疗方法。方法：根据病史并结合脐孔或膀胱美蓝注射试验、膀胱镜检查、瘘管造影、B超、CT等辅助检查方法诊断脐尿管异常疾病9例,并进行相应手术治疗。结果：手术及病理检查证实脐尿管瘘并感染3例,脐尿管囊肿并感染3例,脐尿管窦道并感染1例,膀胱顶部憩室1例,确诊后自动出院1例。患者术后排尿正常,8－18天痊愈出院,随访至今无复发及癌变。结论：脐孔或膀胱美蓝注射试验、膀胱镜检查、瘘管造影、B超、CT等辅助检查为有效的诊断措施;手术范围应以尽可能彻底切除脐尿管及其异常组织为宜。     

Persistent multiple urachal complex. Echographic-surgical correlations]

Urachus is a tubular structure lined between foetal bladder and the umbilicus and is susceptible to complete or partial involution after birth. Persistence of the urachus results in a wide spectrum of anomalies: patent urachus, vesicourachal diverticulum, urachal sinus and cysts are more frequently seen than rare multiple urachal remnants. This kind of pathology focuses the problem of differential diagnosis (tumours, omental and ovarian cysts, vesical diverticulum or duplication) and may be complicated by a superinfection. The Authors discuss a bizarre multiple urachal remnant, presenting with urinary tract symptoms, which may be clinically confused with acute appendicitis or Meckel's diverticulitis. Contribution of sonography for a complete diagnosis is stressed, such as the precise correlation with surgical findings.     

脐尿管疾病的诊治研究及文献复习(附14例报告)

目的：探讨脐尿管疾病的诊断与治疗方法。方法：根据病史并结合经脐孔或膀胱美蓝灌注试验、膀胱镜检查、瘘管造影、B超、CT等辅助检查方法诊断为脐尿管异常疾病14例，并进行相应手术治疗。结果：手术及病理检查证实为脐尿管瘘并感染2例。脐尿管囊肿并感染5例。脐尿管窦道并感染5例。原发性脐尿管鳞状细胞癌1例。患者术后排尿正常。8～18d痊愈出院。1例脐尿管瘘并感染者拒绝手术出院。结论：经脐孔或膀胱美蓝灌注试验、膀胱镜检查、瘘管造影、B超、CT等辅助检查为脐尿管疾病有效的诊断措施；手术范围应以尽可能彻底切除脐尿管及其异常组织为宜。     

Laparoscopic radical excision of urachal sinus

Persistent urachus is a rare congenital anomaly. Various types of remnants have been described including cyst, alternating sinus, patent urachus, diverticulum, and sinus. The most common presenting symptom of urachal sinus is umbilical discharge. Radical excision of the remnant, with or without a bladder cuff, is essential to prevent future malignant degeneration or recurrence of the remnant. Although open surgical excision has been the treatment of choice for many years, the laparoscopic approach has become an attractive alternative because of its association with less postoperative pain, better cosmesis, and rapid convalescence. Laparoscopic radical excision of a urachal sinus was performed in a 16-year-old female patient who presented with umbilical discharge.     

Blasenruptur durch spontane Perforation einer infizierten Urachuszyste

Anomalies of the fetal urachus are rare. Normally, the postnatal urachus presents as a fibrous band extending from the bladder to the umbilicus. Urachal cysts may occur in postnatal life. Spontaneous perforation of urachal cysts is a very rare condition, which clinically may not be distinguishable from other acute abdominal conditions. We report a case of a 63-year-old male with a history of recurrent urinary tract infections and a bladder rupture caused by a spontaneous perforation of an infected urachal cyst. The symptomatology showed abdominal rigidity and pain, a palpable mass in the lower abdomen, and hematuria. Laboratory findings showed leukocytosis and an increased CRP level. The bladder rupture was confirmed by cystography. Bacteriologic examination identified Proteus vulgaris, Corynebacterium species, and Klebsiella pneumoniae. Most of the published cases in the literature report about intraperitoneal perforation of infected urachal cysts. In the present case, we found a spontaneous perforation of an infected urachal cyst leading to an extraperitoneal bladder rupture with an extraperitoneal limitation of the infection. The definitive therapy was complete surgical excision including a cuff of the bladder, drainage, and systemic broad-spectrum and local application of antibiotics. The further course was uneventful.     

Relevance of infection in children with urachal cysts

OBJECTIVE: To assess the role of infection in the management of children with urachal cysts. METHODS: A retrospective study on 10 children with urachal cysts operated on over an 11-year period (from 1987 to 1998) was performed. Uncomplicated urachal cysts were found in 2 children who underwent primary cyst removal. The remaining 8 were admitted with severe sepsis due to the presence of a urachal abscess; they were managed by a staged approach including percutaneous drainage and delayed cyst removal. The diagnosis of urachal cyst was readily made by ultrasound in all the 10 patients (100%). In 1 patient with urachal abscess, computed tomography provided additional information. RESULTS: The postoperative course was uneventful in 9 of 10 children (90%). A 5-year-old female patient developed peritonitis following urachal abscess rupture into the peritoneal cavity, which resulted in additional surgery and prolonged hospitalization. CONCLUSIONS: (1) Ultrasound is an excellent diagnostic tool for patients with urachal cysts. (2) A renal screening ultrasound must be included in the preoperative work-up. (3) A thorough urological assessment is indicated in patients with abnormal renal ultrasound of recurrent urinary infections. (4) At present, a staged surgical procedure still remains the most effective surgical option in children with urachal cyst.     

脐尿管疾病的诊断及治疗(附11例报告)

目的探讨脐尿管疾病的诊断与治疗方法。方法分析总结我院从1994年7月至2005年3月间收治的11例脐尿管疾病患者的临床资料。结果手术及病理检查证实脐尿管囊肿合并感染5例、脐尿管慢性非特异性肉芽肿2例、脐尿管瘘合并感染1例、脐尿管窦道合并感染2例、脐尿管鳞状细胞癌1例。患者术后恢复良好,排尿正常,9~21d出院。结论膀胱镜检查、经脐孔或膀胱美蓝灌注实验、瘘管造影、B超、CT等检查对脐尿管疾病的诊断及治疗具有重要意义,病理检查为确诊依据,手术应尽可能彻底切除脐尿管及病变组织。     

A case of infected urachal cyst in an 8-year-old boy

An 8-year-old boy with infected urachal cyst presenting with macroscopic hematuria, pain on urination and high fever attack is reported. He had recurrent episodes of cystitis. At admission, a quail-egg sized solid tumor was palpated in the midline of his lower abdomen. The urine was infected. Ultrasonographic examination revealed an oval tumor 2 x 2.7 cm in diameter at the dome of the bladder with a thin funicular structure running toward the umbilicus. Cystoscopy revealed a round tumor covered with hyperemic epithelia. Transurethral biopsy revealed no malignant lesions of the epithelia. Partial cystectomy with excision of the funicular urachal ligament was performed. The pathological findings were consistent with persistent urachus with chronic inflammation. We reviewed 210 cases of infected urachal cysts reported in the Japanese literature.     

腹腔镜手术切除六例小儿脐尿管囊肿的临床报告

目的探讨腹腔镜治疗小儿脐尿管囊肿的时机、方法和效果。 方法回顾性分析自2014年10月至2017年10月在中山大学附属第一医院和深圳市儿童医院小儿外科收治的6例经腹腔镜治疗的小儿脐尿管囊肿临床资料。女2例,男4例,平均年龄5岁1个月。术前均经超声和CT确定诊断,脐尿管囊肿大小为1.1～3.0 cm,4例位置近膀胱,2例在脐尿管的中间位。3例无症状的择期手术,3例有症状的在感染控制后择期手术,全部6例均采用脐部和平脐两侧腹壁进三个曲卡的方法,进行了腹腔镜脐尿管囊肿切除术。 结果本组患儿手术全部顺利完成,术中囊肿均完整无破溃,手术时间45～80 min,平均60 min。术中和术后无并发症。病理均符合诊断。随访6～43个月,6例患儿均恢复顺利,腹部切口瘢痕不明显,患儿家属满意。 结论小儿脐尿管囊肿腹腔镜下可完整切除,手术安全、有效、恢复快速,外观良好。     

A case of patent urachus in an adult male

A 31-year-old man was referred to our hospital for evaluation of urachal rest. The history of his present illness dated back to birth, when the umbilicus was projected and urinary discharge was noted. At that time, the symptom of discharge had spontaneously subsided. At the age of 22, however, the patient again experienced discharge from the umbilicus. Although he did not seek treatment, after six years this symptom disappeared. Around this time, however, pyuria was revealed during medical examination, and abdominal ultrasonography (US) suggested the presence of urachal rest. At the time of hospitalization, physical examination revealed that the patient's right testis was not palpable. He was diagnosed with patent urachus with hemilateral aplasia and monorchism by US, computed tomography, magnetic resonance imaging and cystoscopy. The patient subsequently underwent radical operation. Patent urachus in adults is very rare, and only a few cases have been reported. To our knowledge, only one previously reported case involved a recurrence after spontaneous healing. Further, this is the first report of a patient with patent urachus with hemilateral aplasia and monorchism. Radical operation is generally recommended, based on the fact that very few cases heal conservatively.     

Laparoscopic treatment of urachal remnants

ObjectivesThe urachus is a vestigial obliterated structure derived from the alantois. Failure of this involution process originates patent urachal remnants. Surgery is the treatment of choice as it prevents both recurrence of symptoms and malignant transformation. The purpose of this study is to present our experience in the laparoscopic management of this pathology.Material and methodsThree male patients (mean age 39 years) underwent laparoscopic excision of urachal remnants. Two patients were diagnosed with an asymptomatic cyst and one patient with urachal sinus presenting with umbilical discharge. A three-port technique was used to remove the whole urachus tract from the umbilicus to the bladder dome, together with a small bladder patch.ResultsMean operating time was 94 min and blood loss was minimal. One patient had small intra-operative bladder rupture, successfully managed with adequate closure. No post-operative complications were observed and all patients were discharged on the second postoperative day. Two years later there was no evidence of recurrence.ConclusionsUrachal remnants can be successfully treated by laparoscopic surgery, with advantages in terms of morbidity, recovery and cosmetic outcome. Large number, comparative studies are still needed to definitely establish it as the gold standard treatment.     

Laparoscopic management for urachal cyst in a 9-year-old boy

We report a boy with urachal cyst managed laparoscopically. A 9-year-old boy was referred from another hospital with a history of low abdominal pain. We laparoscopically excised the urachal cyst, removing all structures within the umbilicovesical fascia, including the urachus and each medial umbilical ligament, as well as the associated peritoneum from the umbilicus to the bladder dome. Laparoscopic management of urachal disease can be performed safely, with minimal postoperative pain, excellent cosmetic results and early ambulation. We advocate the use of laparoscopic treatment of urachal anomalies in children.     

Peritonitis due to intraperitoneal perforation of infected urachal cysts

Acute bacterial peritonitis due to intraperitoneal perforation of an infected urachal cyst represents a potentially lethal complication of the rare anomalies of the fetal urachus. We report four cases of this disease, including what we believe is the first to have been correctly diagnosed prior to operation. All four patients underwent emergency laparotomy and curative excision of the urachal remnant. Review of our four cases plus seven previously reported cases disclosed the perforated urachal cyst to be predominantly a disease of young males who initially have acute peritonitis but often without specific indication of a urachal anomaly. Bacteriologic examination has identified a wide variety of infecting organisms. Umbilical sinography or abdominal ultrasonography may allow accurate preoperative diagnosis. Broad-spectrum antibiotic coverage and laparotomy are indicated and excision of the entire urachal remnant is consistently curative.     

The giant umbilical cord: an unusual presentation of a patent urachus

Umbilical cord anomalies remain a frequent newborn nursery consultation for the pediatric surgeon. The authors report on a giant umbilical cord associated with a patent urachus. Although it is an uncommon anomaly, operative exploration must be carried out to repair the associated urachal remnant.     

Acute Peritonitis Caused by Intraperitoneal Rupture of an Infected Urachal Cyst: Report of a Case

Embryologically, the urachus is the tubular structure that connects the dome of the bladder to the umbilicus. Incomplete obliteration of the urachal lumen results in several anomalies. The most common urachal abnormality is the urachal cyst and, while intraperitoneal rupture of an infected urachal cyst is very rare, acute peritonitis resulting from intraperitoneal rupture is the most dangerous of all complications associated with urachal anomalies. We report the case of an 80-year-old woman who underwent an emergency laparotomy for lower abdominal pain and signs of acute peritonitis, which revealed intraperitoneal rupture of an infected urachal cyst. Infected urachal cysts with intraperitoneal rupture are often misdiagnosed as a common acute abdomen and result in emergency exploratory laparotomy. These patients should be managed by complete excision of the urachal remnant to prevent any malignant change occurring, as malignant changes have been reported. Received: September 6, 2001 / Accepted: July 2, 2002 Reprint requests to: M. Ohgaki, 6-2-118 Ichichoda-cho, Sakyo-ku, Kyoto 606-0954, Japan