Abstract
BackgroundThe urachus is an embryological structure of the urogenital sinus and allantoid that connects the allantois to the early bladder in fetal life and then remains as the median umbilical ligament connecting the umbilicus to the dome of the bladder. An early laparoscopic procedure could trigger a quiescent urachal remnant to become symptomatic, causing a lesion or infection either during carbon oxide contamination or insufflation or a periumbilical or suprapubic port placement.Case presentationA 15-year-old girl complaining of supra-pubic abdominal pain. About 2 months previously, she had undergone laparoscopic appendectomy for acute appendicitis, and early postoperative period was uneventful. She underwent a robotic-assisted excision of a urachal cyst.ConclusionsIt has been suggested that early laparoscopic procedures could trigger previously asymptomatic urachal remnants to become symptomatic. Robot-assisted excision of a urachal cyst is a safe, effective alternative to open surgery in children.
Highlights
The urachus is an embryological structure of the urogenital sinus and allantoid that connects the allantois to the early bladder in fetal life and remains as the median umbilical ligament connecting the umbilicus to the dome of the bladder
It has been suggested that early laparoscopic procedures could trigger previously asymptomatic urachal remnants to become symptomatic
We report a case of a young girl that underwent a robotic-assisted excision of a symptomatic urachal cyst following laparoscopic appendectomy
Summary
The urachus is an embryological structure of the urogenital sinus and allantoid that connects the allantois to the early bladder in fetal life and remains as the median umbilical ligament connecting the umbilicus to the dome of the bladder [1,2,3]. We report a case of a young girl that underwent a robotic-assisted excision of a symptomatic urachal cyst following laparoscopic appendectomy. Preoperative Pediatric Appendicitis Score (PAS) was 7/10 and abdominal ultrasound had shown an appendix with a 7-mm diameter, with peri-appendiceal fluid The constant pain she complained of did not radiate and was 5/10 on the pain scale. An abdominal ultrasound and a magnetic resonance imaging (MRI) scan did not document any pathological abnormality, rather a supra-vesical cyst consistent with an enlarged urachal cyst (Fig. 1). For this reason, after informed consent was obtained, the patient underwent a robotic-assisted excision of the urachal cyst.
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