Patent Urachus Presenting as Acute Abdomen

Abstract

The urachus is an epithelial tubular structure located in the midline that spreads from the anterosuperior part of the bladder to the navel, connecting the apex of the urinary bladder with the allantois in the fetus, and is involved in forming the umbilical structures. When the urachal tract is not completely obliterated during embryonic development, bladder diverticulum, urachal cyst, umbilical polyp, or patent urachus may result. Therefore, making a differential diagnosis prior to surgery is not easy. A 30-year-old woman presented to the outpatient clinic with severe abdominal pain in the suprapubic and infraumbilical regions of 12 hours of evolution. There were no urinary symptoms, and she was afebrile. Physical examination revealed periumbilical tenderness and intense pain on abdominal palpation in the suprapubic and abdominal regions. An ultrasound scan revealed a patent urachus. The striated structure was present between the bladder and the umbilicus. After undergoing preoperative examinations, the patient was submitted to surgical treatment, and the final pathology of the resected segment confirmed the ultrasound diagnosis. Urachal pathology in adulthood is rare. Often its presentation as acute abdominal pain is nonspecific and, as such, may cause many diagnostic problems. Differential diagnosis should include acute appendicitis and other inflammatory disorders. The patient's history and physical examination are crucial for the correct diagnosis. It is important to have a thorough understanding of the embryology, anatomy, presentation, and relevant investigations for these anomalies. Ultrasound can be helpful for diagnosing the pathology of urachal remnants.