Colourachal Fistula in an Adult Presenting with Feculent Umbilical Drainage

Abstract

A 26-year-old female presented with a 2-week history of fever, left lower abdominal pain and feculent drainage from the umbilicus. During the previous month the patient had also noticed increased urinary frequency but denied any hematuria, dysuria or pneumaturia. She had no significant changes in bowel movements. She denied any previous medical conditions or surgeries. Aside from abdominal tenderness and umbilical drainage, the examination was unremarkable. Urine culture and microscopic analysis were negative, while cultures taken of the umbilical fluid grew Escherichia coli. Abdominal computerized tomography (CT) revealed a urachal remnant containing gas and an adjacent inflammatory mass from sigmoid diverticulitis (see figure). Cystoscopy demonstrated edematous changes at the bladder dome with no obvious fistula. The patient was placed on a 6-week course of levofloxacin and metronidazole with resolution of the abdominal pain, although the umbilical drainage persisted. The patient underwent elective excision of the urachal remnant with bladder cuff and en bloc sigmoid colectomy with primary end-to-end colonic anastomosis. Intraoperatively, the patient had an abscess from perforated sigmoid diverticulitis and fistulization to the urachus. Pathological examination showed a patent urachal remnant measuring 3 cm in diameter, cystitis glandularis of the bladder dome, sigmoid diverticulitis and a colourachal fistula. Postoperative course was uneventful with removal of the urinary catheter on day 11 and complete resolution of symptoms.