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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.

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Congenital and acquired urachal abnormalities. (a) Normal urachus; (b) congenital patent urachus; (c) acquired umbilical urachal sinus; (d) acquired vesicourachal diverticulum; (e) acquired alternating urachal sinuses; (f) acquired urachal sinus.
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fig3: Congenital and acquired urachal abnormalities. (a) Normal urachus; (b) congenital patent urachus; (c) acquired umbilical urachal sinus; (d) acquired vesicourachal diverticulum; (e) acquired alternating urachal sinuses; (f) acquired urachal sinus.

Mentions: Two main urachal pathologies are described, congenital and acquired. A congenital patent urachus is typically identified in childhood by urine draining via the umbilicus. The acquired pathology has been further categorized into four types: (1) an umbilical urachal sinus, whereby the tract is dilated at the umbilicus and opens directly to the atmosphere, (2) a vesicourachal diverticulum, which compromises any short segment dilatation of the proximal portion of the urachus, (3) alternating urachal sinuses with fibromuscular tissue interposed, and (4) a urachal cyst involving a noncontiguous short segment dilatation of the urachus (Figure 3) [1]. The largest review of urachal cyst pathology reviewed three hundred and fifteen cases with nearly half being attributed to the congenital patent urachus. The acquired anomaly compromised 52.4%. Of the acquired type, the urachal cyst comprised 58.8% and was most prone to present as an infected process [2]. Acquired urachal pathology can be difficult to diagnose clinically as the associated inflammation can mimic many disease processes and mandate a broad differential diagnosis.


Urachal Cyst Causing Small Bowel Obstruction in an Adult with a Virgin Abdomen
Congenital and acquired urachal abnormalities. (a) Normal urachus; (b) congenital patent urachus; (c) acquired umbilical urachal sinus; (d) acquired vesicourachal diverticulum; (e) acquired alternating urachal sinuses; (f) acquired urachal sinus.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig3: Congenital and acquired urachal abnormalities. (a) Normal urachus; (b) congenital patent urachus; (c) acquired umbilical urachal sinus; (d) acquired vesicourachal diverticulum; (e) acquired alternating urachal sinuses; (f) acquired urachal sinus.
Mentions: Two main urachal pathologies are described, congenital and acquired. A congenital patent urachus is typically identified in childhood by urine draining via the umbilicus. The acquired pathology has been further categorized into four types: (1) an umbilical urachal sinus, whereby the tract is dilated at the umbilicus and opens directly to the atmosphere, (2) a vesicourachal diverticulum, which compromises any short segment dilatation of the proximal portion of the urachus, (3) alternating urachal sinuses with fibromuscular tissue interposed, and (4) a urachal cyst involving a noncontiguous short segment dilatation of the urachus (Figure 3) [1]. The largest review of urachal cyst pathology reviewed three hundred and fifteen cases with nearly half being attributed to the congenital patent urachus. The acquired anomaly compromised 52.4%. Of the acquired type, the urachal cyst comprised 58.8% and was most prone to present as an infected process [2]. Acquired urachal pathology can be difficult to diagnose clinically as the associated inflammation can mimic many disease processes and mandate a broad differential diagnosis.

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