Pathology of the urachus in children

Abstract

Introduction: Urachal malformations, arising from incomplete obliteration of the urachus during fetal development, are rare conditions predominantly seen in children. They present various clinical challenges due to their potential for infection and malignant transformation. Objective: This study aims to report on the epidemiological, diagnostic, and therapeutic aspects of urachal malformations in a pediatric population. Patients and methods: A retrospective study was conducted in the pediatric visceral surgery department of the Hassan II University Hospital of Fez over a period of 7 years (2014-2021), involving 10 cases of urachal pathology. Clinical presentations, radiological findings, treatment approaches, and outcomes were analyzed. Results: The patients ages ranged from 1 to 15 years, with an equal gender distribution. The most common clinical presentation was umbilical discharge. Abdominal ultrasound was the primary diagnostic tool, supplemented by CT scans in six cases. Surgical treatment, typically involving midline sub-umbilical or peri-umbilical approaches, was performed in all cases, revealing 7 cysts, 2 fistulas, and 1 sinus. Postoperative outcomes were generally favorable, with an average hospital stay of 12 days. However, there was one recurrence and one wound infection. The mean follow-up period was 2.5 years. Conclusion: Early diagnosis and appropriate surgical intervention are crucial for managing urachal malformations in children. Radiological imaging, particularly ultrasound, plays a vital role in diagnosis. While surgical excision of the urachus, including the bladder dome collar, is the preferred treatment to prevent recurrence and potential malignancy, careful follow-up is necessary to monitor for complications. Further studies are recommended to refine treatment protocols and improve patient outcomes.