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Urachal Cyst Causing Small Bowel Obstruction in an Adult with a Virgin Abdomen

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ABSTRACT

Introduction. A patent urachus is a rare congenital or acquired pathology, which can lead to complications later in life. We describe a case of urachal cystitis as the etiology of small bowel obstruction in an adult without prior intra-abdominal surgery. Case Report. A 64-year-old male presented to the acute care surgery team with a 5-day history of right lower quadrant abdominal pain, distention, nausea, and vomiting. He had a two-month history of urinary retention and his past medical history was significant for benign prostate hyperplasia. On exam, he had evidence of small bowel obstruction. Computed tomography revealed high-grade small bowel obstruction secondary to presumed ruptured appendicitis. In the operating room, an infected urachal cyst was identified with adhesions to the proximal ileum. After lysis of adhesions and resection of the cyst, the patient was subsequently discharged without further issues. Conclusion. Although rare, urachal pathology should be considered in the differential diagnosis when evaluating a patient with small bowel obstruction without prior intraabdominal surgery, hernia, or malignancy.

No MeSH data available.


Related in: MedlinePlus

CT scan demonstrating a Foley catheter in the decompressed bladder with (a) demonstration of a urachal cyst connection from the anterior reflection of the bladder to the umbilicus with dilated small bowel loops and adjacent fat stranding and (b) a normal appearing posterior appendix off the cecum.
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fig1: CT scan demonstrating a Foley catheter in the decompressed bladder with (a) demonstration of a urachal cyst connection from the anterior reflection of the bladder to the umbilicus with dilated small bowel loops and adjacent fat stranding and (b) a normal appearing posterior appendix off the cecum.

Mentions: A computed tomography (CT) scan was performed which demonstrated fat stranding in the right inferior abdominal cavity with an adjacent fluid collection, distended small bowel loops with fecalization, and a clear transition point at the proximal ileum. The preliminary radiologic interpretation was that of an intra-abdominal abscess secondary to a ruptured appendicitis with associated high-grade small bowel obstruction. Following the insertion of a nasogastric tube and the administration of antibiotics, the patient was taken to the operating room. Prior to incision, the CT scan was reexamined and a fluid collection with surrounding fat stranding was noted extending from the bladder to the umbilicus with a transition point at the phlegmon (Figure 1(a)). Moreover, a normal appendix was visualized (Figure 1(b)).


Urachal Cyst Causing Small Bowel Obstruction in an Adult with a Virgin Abdomen
CT scan demonstrating a Foley catheter in the decompressed bladder with (a) demonstration of a urachal cyst connection from the anterior reflection of the bladder to the umbilicus with dilated small bowel loops and adjacent fat stranding and (b) a normal appearing posterior appendix off the cecum.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5120188&req=5

fig1: CT scan demonstrating a Foley catheter in the decompressed bladder with (a) demonstration of a urachal cyst connection from the anterior reflection of the bladder to the umbilicus with dilated small bowel loops and adjacent fat stranding and (b) a normal appearing posterior appendix off the cecum.
Mentions: A computed tomography (CT) scan was performed which demonstrated fat stranding in the right inferior abdominal cavity with an adjacent fluid collection, distended small bowel loops with fecalization, and a clear transition point at the proximal ileum. The preliminary radiologic interpretation was that of an intra-abdominal abscess secondary to a ruptured appendicitis with associated high-grade small bowel obstruction. Following the insertion of a nasogastric tube and the administration of antibiotics, the patient was taken to the operating room. Prior to incision, the CT scan was reexamined and a fluid collection with surrounding fat stranding was noted extending from the bladder to the umbilicus with a transition point at the phlegmon (Figure 1(a)). Moreover, a normal appendix was visualized (Figure 1(b)).

View Article: PubMed Central - PubMed

ABSTRACT

Introduction. A patent urachus is a rare congenital or acquired pathology, which can lead to complications later in life. We describe a case of urachal cystitis as the etiology of small bowel obstruction in an adult without prior intra-abdominal surgery. Case Report. A 64-year-old male presented to the acute care surgery team with a 5-day history of right lower quadrant abdominal pain, distention, nausea, and vomiting. He had a two-month history of urinary retention and his past medical history was significant for benign prostate hyperplasia. On exam, he had evidence of small bowel obstruction. Computed tomography revealed high-grade small bowel obstruction secondary to presumed ruptured appendicitis. In the operating room, an infected urachal cyst was identified with adhesions to the proximal ileum. After lysis of adhesions and resection of the cyst, the patient was subsequently discharged without further issues. Conclusion. Although rare, urachal pathology should be considered in the differential diagnosis when evaluating a patient with small bowel obstruction without prior intraabdominal surgery, hernia, or malignancy.

No MeSH data available.


Related in: MedlinePlus