Crohn disease has a wide spectrum of clinical presentations and rarely can present with complications such as a bowel stricture or fistula. In this case report, we describe a 17-year-old male who presented with a history of recurrent anterior abdominal wall abscesses and dysuria. He was diagnosed with Crohn disease and also found to have a fistulous communication between the terminal ileum and a patent urachus. An ileocecectomy with primary anastomosis and complete resection of the abscess cavity was performed. He is on azathioprine for maintenance therapy and currently in remission. Clinicians should have a high index of suspicion for this complication in Crohn disease patients presenting with symptoms suggestive of urachal anomalies such as suprapubic abdominal pain, dysuria, umbilical discharge, and periumbilical mass.
Abdominal Pain ; Abdominal Wall ; Abscess ; Adolescent ; Azathioprine ; Constriction, Pathologic ; Crohn Disease* ; Dysuria ; Fistula* ; Humans ; Ileum ; Inflammatory Bowel Diseases ; Intestinal Fistula ; Male ; Urachus

We report a very rare case of urachal xanthogranuloma. In this case, the inflammation recurred after 9 months even though it was removed by surgical resection. A 43-year-old woman presented with low abdominal walnut sized round mass, mild abdominal pain, and no specific voiding symptoms. Through radiologic evaluation with computed tomography (CT), we observed an infiltration in surrounding tissues of urachal mass from anteriosuperior aspect of bladder until umbilicus, so urachus inflammation as well as malignant tumor of urachus origin was suspected. Urachal mass excision and partial cystectomy were conducted with low midline incision and it was reported pathologically as xanthogranulomatous inflammation. Afterwards the patient lived without inconvenience but after 9 months she returned because of pain and palpable nodule in the right lower abdominal area. Despite taking antibiotics, there was no improvement and abscess formation was observed in CT. Finally, its symptoms improved after abscess incision and drainage.
Abdominal Pain ; Abdominal Wall ; Abscess ; Adult ; Anti-Bacterial Agents ; Cystectomy ; Drainage ; Female ; Humans ; Inflammation ; Juglans ; Umbilicus ; Urachus ; Urinary Bladder

No abstract available.
Abscess/*diagnosis ; Fibrosis ; Humans ; Intestine, Small/pathology/surgery ; Male ; Peritonitis/diagnosis ; Tomography, X-Ray Computed ; Urachus/*abnormalities ; Young Adult

Humans ; Infant, Newborn ; Infant, Newborn, Diseases ; diagnostic imaging ; Male ; Ultrasonography ; Urachus ; abnormalities ; diagnostic imaging ; Vitelline Duct ; abnormalities ; diagnostic imaging

Urachal mucinous tumor of uncertain malignant potential is very rare and is characterized by a multilocular cyst showing the proliferation of atypical mucin-secreting cells without stromal invasion. As in ovarian and appendiceal borderline tumors, it represents a transitional stage of mucinous carcinogenesis in the urachus. In addition, this tumor may recur locally and develop into pseudomyxoma peritonei. Due to its scarcity and diagnostic challenges, we report a mucinous tumor of uncertain malignant potential arising in the urachus.
Cystadenoma, Mucinous ; Mucins ; Pseudomyxoma Peritonei ; Urachus

OBJECTIVE: To analyze the multislice spiral computer tomography (MSCT) manifestations and its value in the diagnosis of urachus lesions. METHODS: A total of 26 patients with urachus disease diagnosed by pathological examination in our hospital between October 2007 and May 2011 were included in this study. We retrospectively analyzed MSCT images on the size, location, and shape character of the foci, and the image features of Retzius space. RESULTS: In the group, 12 patients had simple urachal cyst with homogeneous fluid filling the cavity with thin wall in CT scanning; five had infected urachal cyst with thickened and enhanced wall, some patch and strip appearing in Retzius space surrounding the lesion; two had infected urachal sinus, and another 3 had urachus leakage. Four had urachal tumor showing irregular cysticsolid mass over the apex of the bladder with apparent enhancement in contrast imaging, and 2 had calcification. Invasion of the bladder wall was found in 4 patients, extensive invasion of the ileum, rectum, uterus and retroperitoneal lymph nodes was found in 1. CONCLUSION MSCT scan can demonstrate the location, shape, extent of the lesion as well as the relation with adjacent structures, thereby providing valuable information for the diagnosis and differential diagnosis of urachus lesions.
Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infections ; complications ; Male ; Middle Aged ; Multidetector Computed Tomography ; Urachal Cyst ; complications ; diagnostic imaging ; Urachus ; diagnostic imaging ; pathology ; Young Adult

PURPOSE: In this study, we report our initial experience with robot-assisted laparoscopic partial cystectomy (RLPC) in urachal diseases. MATERIALS AND METHODS: Two men and two women with a mean age of 51.5+/-9.3 years underwent RLPC between June 2009 and December 2009. In each case, a single surgeon using the da Vinci-S robotic system (Intuitive Surgical, Sunnyvale, CA, USA) used a transperitoneal approach with a 0 degrees robotic camera. After careful observation of the intravesical portion of the mass, the mass was excised by use of monopolar scissors circumferentially. The bladder was closed in two layers with watertight running sutures made with 2-0 Vicryl. RESULTS: The mean operative time was 198 minutes (range, 130-260 minutes), the mean console time was 111 minutes (range, 70-150 minutes), and the mean estimated blood loss was 155 ml. The urethral catheter was removed on postoperative day 7 after a normal cystogram, and the surgical drain was removed on postoperative day 2.5 (range, 2-3 days). The mean hospital stay was 6 days (range, 4-7 days). There were no major complications. The pathology report revealed that one patient had a urachal cystadenoma, two patients had a urachal cyst, and one patient had a patent urachus. CONCLUSIONS: Our initial experience with RLPC for benign urachal disease is that it is a safe and feasible treatment modality. However, more cases are required to confirm the efficacy of RLPC.
Cystadenoma ; Cystectomy ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Operative Time ; Polyglactin 910 ; Robotics ; Running ; Sutures ; Urachal Cyst ; Urachus ; Urinary Bladder ; Urinary Catheters

A case of bladder prolapse through a patent urachus is reported in a female infant born with a large, red, tubular mass inferior to the umbilical cord. A cystic mass communicating with fetal bladder was detected by prenatal ultrasound performed at 20(+2) weeks of gestation. A fetal MRI was also performed to confirm the diagnosis and to exclude associated fetal anomalies. At 40(+4) weeks, the cystic mass was no longer present and a new small solid mass was noted at the fetal abdominal wall. After birth, a protruded mucosal mass inferior to the umbilical cord was noted, and catheterization confirmed communication between the protruded mass and the urinary bladder. On the second day of life, reduction of the bladder and partial resection of the urachus was performed. A voiding cystourethrogram showed good bladder capacity and no vesicoureteral reflux. The patient voided well and was discharged after 10 days. Here, we present a case of urinary bladder prolapse through a patent urachus, diagnosed by fetal sonography and this is the first case reported that was treated by simple excision without complication.
Abdominal Wall ; Catheterization ; Catheters ; Cystocele ; Female ; Humans ; Infant ; Infant, Newborn ; Parturition ; Pregnancy ; Prolapse ; Umbilical Cord ; Urachus ; Urinary Bladder ; Vesico-Ureteral Reflux

A case of bladder prolapse through a patent urachus is reported in a female infant born with a large, red, tubular mass inferior to the umbilical cord. A cystic mass communicating with fetal bladder was detected by prenatal ultrasound performed at 20(+2) weeks of gestation. A fetal MRI was also performed to confirm the diagnosis and to exclude associated fetal anomalies. At 40(+4) weeks, the cystic mass was no longer present and a new small solid mass was noted at the fetal abdominal wall. After birth, a protruded mucosal mass inferior to the umbilical cord was noted, and catheterization confirmed communication between the protruded mass and the urinary bladder. On the second day of life, reduction of the bladder and partial resection of the urachus was performed. A voiding cystourethrogram showed good bladder capacity and no vesicoureteral reflux. The patient voided well and was discharged after 10 days. Here, we present a case of urinary bladder prolapse through a patent urachus, diagnosed by fetal sonography and this is the first case reported that was treated by simple excision without complication.
Abdominal Wall ; Catheterization ; Catheters ; Cystocele ; Female ; Humans ; Infant ; Infant, Newborn ; Parturition ; Pregnancy ; Prolapse ; Umbilical Cord ; Urachus ; Urinary Bladder ; Vesico-Ureteral Reflux

Urachal adenocarcinomas are very rare and about one third of these neoplasms arise in urachal remnants. To demonstrate the origin of the urachal adenocarcinoma is not easy, but it is very important for managing patient care. We report on a 35-year-old man who complained of a palpable mass in the periumbilical area. The mass was incidentally identified 10 days earlier. Computed tomography revealed a well-defined enhancing mass with internal calcification and septation abutting on the dome of the urinary bladder. The clinical diagnosis was urachal cancer, which seemed to invade the urinary bladder. Thus, we performed mass excision and partial resection of the bladder. Histopathologically, the mass was diagnosed as mucinous cystadenocarcinoma originating from urachal remnants that showed an unusual expression of alpha-methylacyl-coenzyme A racemase (AMACR). To our knowledge, this report is the first case of AMACR-expressing urachal adenocarcinoma arising in the abdominal wall.
Abdominal Wall* ; Adenocarcinoma* ; Adult ; Biomarkers ; Cystadenocarcinoma, Mucinous ; Diagnosis ; Humans ; Patient Care ; Urachus ; Urinary Bladder