Necrotizing Fasciitis: A Rare Complication of an Infected Urachal Remnant in Adults

Abstract

The urachus is an embryological structure that usually undergoes obliteration but may remain patent, causing disorders later in life. Urachal diseases are rare and mainly present in childhood. They are classified as congenital or acquired. Incomplete regression of the urachal lumen results in a completely or partially patent duct, which may lead to clinical complications. Congenital anomalies occur when the urachus remains patent, usually resulting in a urachal fistula at birth. In acquired urachal disorders, the urachal canal closes postnatally, then partially reopens later in life. Although increased vesicular pressure has been suggested as the cause of reopening, the precise etiology is unknown. An acquired patent urachal remnant may lead to 5 possible sequelae—a fistula between bladder and umbilicus, a urachal sinus, a vesicourachal diverticulum with patency at either end, a urachal cyst and an alternating discharging sinus. Anomalies are usually asymptomatic but may present in adult life following infection of the remnant.1 We report a case of necrotizing fasciitis complicating an infected urachal remnant. This complication is highly unusual and to our knowledge has not been previously described in an adult.