Patent Urachus Research Articles

Patent Urachus with Stone in Adult Male: A Rare Case Report

Patent Urachus with Stone in Adult Male: A Rare Case Report

Crohn’s disease manifesting as ileo-urachal fistula: Two cases reports and review of literatures

Introduction: A fistula involving a patent urachus in a patient with Crohn’s disease is rare. Here we report ileourachal fistula formation in two patients with Crohn’ disease.Case presentations: The first patient was a 29-year-old man with Crohn’s disease and ileitis, and the second patient was a 43-year-old man with Crohn’s disease and ileitis. One of the patients showed pus/fecal discharge via the umbilicus. Both patients were eventually diagnosed with an ileourachal fistula associated with Crohn’s disease. In the first patient, the urachal remnant was connected to the urinary bladder and a Crohn’s disease-related intestinal lesion had formed a fistula to the urachus. In the second patient, a periumbilical inflammatory lesion extended to the bladder through the urachal remnant and to a longitudinal ulcer of the ileal lesion. The first patients underwent partial ileal resection, and partial cystectomy, while the second patient underwent urachal curettage, partial ileal resection, and partial cystectomy. In both.Conclusion: In cases of Crohn’s disease with an enterocutaneous fistula or pus discharge via the umbilicus, an examination to detect an urachal remnant with a fistula from the diseased intestine should be performed.

Umbilicus and its extensive clinical repertoire.

The umbilicus is involved in a wide range of abnormalities in infants and children. The most severe are evident at birth and include exomphalos (omphalocele) and gastroschisis, both of which can be life-threatening but are easy to diagnose. Exomphalos is often associated with other congenital abnormalities, whereas the associated problems in gastroschisis are largely confined to the gut. Infection of the umbilicus in the neonate presents as omphalitis. The causes of a moist umbilicus following separation of the umbilical stump are multiple, from the relatively minor umbilical granuloma or ectopic bowel mucosa to the more significant patent urachus that leaks urine. Patency of the entire vitello-intestinal (omphalomesenteric) tract allows air and faecal fluid to drain through the umbilicus. The clinical manifestations of persistence of the vitello-intestinal tract vary markedly according to which part remains: clinical presentations include melaena and anaemia, closed-loop bowel obstruction and Meckel diverticulitis. An umbilical hernia occurs when the umbilical cicatrix fails to close. On the other hand, the umbilicus has its uses, which range from being a route for intravenous access in the neonate to being a convenient point of access in laparoscopic surgery.

UMBILICAL REGION AFFECTIONS IN RUMINANTS

The aim of the present study is to describe the clinical signs and methods for treatment of 32 cases of umbilical region affections in ruminants recorded during a period of 4 years. Umbilical hernias were the most common umbilical region affection recorded (46.8%) especially in female lambs followed by omphalocele (25%), abscesses (18.8%) and patent urachus (9.4%). Umbilical hernias, omphalocele, patent urachus were congenital detected by the animals’ owners shortly after birth. Abscesses were acquired recorded in adult animals, the pus was found only in the subcutaneous part of the umbilical region. Umbilical hernias, abscesses, and patent urachus were surgically repaired with no post operative complication. For omphalocele, high mortality rate was recorded and only one animal survived surgery.

Umbilical-Urachus Sinus A variant of Patent Urachus Presentation With Management in Adults- A single Center Experience

Umbilical-Urachus Sinus A variant of Patent Urachus Presentation With Management in Adults- A single Center Experience

Associated patent urachus and patent omphalo–mesenteric duct in children

The objective of this article is to review the literature on a very rare association such as patent urachus and a patent omphalo–mesenteric duct in children. Partial or total failure of the obliteration of urachus gives rise to various anomalies, which can be diagnosed both in childhood and in adulthood. The omphalo–mesenteric duct remnants are the most common anomalies of the gastro-intestinal tract, often asymptomatic. The association of patent urachus and a patent omphalo–mesenteric duct in children is very rare. A computer-assisted (PubMed and Google Scholar) search of the pediatric literature to identify all cases of patent urachus and a patent omphalo–mesenteric duct association was performed. We found only eleven cases of the association of patent urachus and a patent omphalo– mesenteric duct in the pediatric literature. All cases except one were males. When reported, all children affected were full term. The clinical sign reported was umbilical spillage. In all cases was reported a lack of healing of the umbilical stump with different clinical pictures, except two cases. Treatments reported were application of silver nitrate, antibiotic cream, povidone iodine, and application of salves and plasters. Various diagnostic examinations were performed. In none of these patients was the possible association with PU and POMD suspected, but it was evidenced only during the surgical excision. The surgical approach was laparotomy in all cases. The association of patent urachus and a patent omphalo–mesenteric duct in children is very rare approached in all cases by laparotomy. This review underlines the importance of evaluating any persisting umbilical lesions without delay when conventional pharmacological therapy fails. Keywords: omphalo–mesenteric duct, patent omphalo–mesenteric duct, patent urachus, remnants, urachus

Patent urachus with bladder prolapse

Abstract We report a term neonate with a congenital patent urachus with bladder prolapse. Initial antenatal fetal morphology ultrasound at 13 weeks gestation revealed a large midline pelvic cyst communicating with the bladder which disappeared on subsequent 23 week ultrasound and instead a small umbilical mass was seen, suspicious of omphalocoele. At birth, an umbilical eversion of the bladder dome through a patent urachus was found and operated on a second day of life with excision of the prolapse and bladder closure. There were no other co-existing anomalies and postoperative complications. With increased reporting on bladder prolapse through a patent urachus, we present a case report with a brief review of published literature.

Umbilical Granuloma in an Eight Year Child

Discharging lesions in the umbilical region are rare but well known in neonatal period. Omphalitis, umbilical granuloma, patent urachus and persistent vitelo-intestinal duct are some of the commonest causes. If such a lesion is found in an older child, a careful detailed history and examination of the lesion can give clue to the diagnosis. We present one such case of a rare case of umbilical granuloma.

Giant Cystic Umbilical Cord Associated with Patent Urachus and Intrauterine Fetal Demise

True cystic structures within the umbilical cord are rare, and when they persist into the second and third trimester, they are often associated with an abnormal karyotype or other developmental abnormalities. Clinically significant pseudocysts resulting from massive edema of the umbilical cord have been associated with a congenitally patent urachus. We present a case of intrauterine fetal demise at 28 weeks' gestation in which cystic dilatation of the umbilical cord was diagnosed prenatally by ultrasound imaging. At autopsy, a congenitally patent urachus was contiguous with the massively edematous umbilical cord.

Prenatal causes of an allantoic cyst with a patent urachus

Prenatal diagnosis of an allantoic cyst with a patent urachus is rare. A urological etiology can sometimes be associated with it. We report 4 cases of allantoic cyst with a patent urachus and reviewed the literature to investigate for any etiology using the keywords “allantoic cyst” and “patent urachus”. Diagnosis of an allantoic cyst with a patent urachus was established during the first or second trimester of pregnancy. In two cases, rupture of prenatal cysts occurred and in one case, we described a prenatal vesicourethral abnormality. Surgery was performed with good results and no complications. A literature review collected 12 studies (15 fetuses) with a sex ratio of 3 boys/1 girl. The cysts ruptured in 2/3 of the cases, and in half of the cases, urinary abnormalities were found before birth (enlarged bladder, bladder prolapse). At birth, one boy had posterior urethral valve (PUV) and 4 boys had a bladder prolapse. The postoperative course was uneventful. We present our series with one case showing the etiology of a patent urachus during prenatal life. Cystoscopy seems to be valuable in the post-natal diagnosis. In the literature, we found one case of PUV. Surgery was performed with good results and no complications.

臍帯ヘルニアを合併した尿膜管開存の 2 例 : 整容的に有用な臍形成術の同時施行による治療

臍帯ヘルニアを合併した尿膜管開存の 2 例 : 整容的に有用な臍形成術の同時施行による治療

Imaging of the Urachus: Anomalies, Complications, and Mimics.

Urachal anomalies are more common than previously thought, with more cases discovered incidentally, because of the increased use of cross-sectional imaging. Although an abnormal persistence of an embryologic communication between the bladder and the umbilicus is often recognized and managed in childhood, it may persist into adulthood, with a greater risk of morbidity. Congenital urachal anomalies that are detected early can benefit from an optimized management including surgical approach with a complete resection of the urachal remnant in cases when spontaneous resolution or medical management has failed. At imaging, the different types of urachal anomalies have a distinct appearance. A patent urachus is recognized as an elongated patent connection between the bladder and the umbilicus. An umbilical-urachal sinus is depicted as a blind focal dilatation at the umbilical end, whereas a vesicourachal diverticulum is a focal outpouching at the vesical end. Urachal cysts are visualized as midline fluid-filled sacs most frequently located near the bladder dome. Complications of urachal anomalies have nonspecific clinical findings and can mimic other abdominal and pelvic processes. Potential complications, such as infection and tumors, should be recognized early to ensure optimal management. Understanding of the embryonic development of the urachus is necessary for the radiologist to diagnose the wide variety of urachal disease. ©RSNA, 2016.

Prenatal and Postnatal Clinical Course of an Urachus Identified as an Allantoic Cyst in the Umbilical Cord.

The aim of this study was to clarify the prenatal and postnatal clinical courses of an urachus identified as an allantoic cyst in the umbilical cord. Allantoic cysts in the umbilical cord were identified in five fetuses over the past 12 years at our hospital. The prenatal and postnatal clinical courses of these patients were retrospectively reviewed. The presence of allantoic cysts in the umbilical cord was first detected at 15 to 27 weeks of gestation. The cysts subsequently became enlarged, reaching a maximum diameter of 34 to 61 mm at 17 to 32 weeks of gestation. The cysts then suddenly disappeared due to spontaneous rupture at 26 to 35 weeks of gestation. After being born at 38 (35-39) weeks of gestation, four patients were diagnosed with a patent urachus requiring surgery in the infantile period and one was diagnosed with an urachal cyst, which is currently being observed without surgery. The presence of an urachus identified as an allantoic cyst in the umbilical cord is frequently associated with spontaneous rupture during the prenatal period, resulting in a patent urachus after birth that requires surgical intervention.

Incidental Diagnosis of Giant Cell Tumor After Urachal Remnant Removal in a Thalassemic Child

Urachal anomalies are relatively uncommon; they usually present in childhood as urachal cysts, urachal sinuses, diverticula, and patent urachus. The malignant involvement of the urachus, although rare in children, is commonly found in adulthood when adenocarcinoma accounts for the majority of the cases, representing up to 20-30% of all adenocarcinomas of the bladder. Urachal tumors of variable histology have been reported in children and adolescents as single case report. We present the first case of a 4-year-old thalassemic boy, with an incidental finding of giant cell tumor arising in an urachal remnant.

Urachal Cyst Causing Small Bowel Obstruction in an Adult with a Virgin Abdomen.

Introduction. A patent urachus is a rare congenital or acquired pathology, which can lead to complications later in life. We describe a case of urachal cystitis as the etiology of small bowel obstruction in an adult without prior intra-abdominal surgery. Case Report. A 64-year-old male presented to the acute care surgery team with a 5-day history of right lower quadrant abdominal pain, distention, nausea, and vomiting. He had a two-month history of urinary retention and his past medical history was significant for benign prostate hyperplasia. On exam, he had evidence of small bowel obstruction. Computed tomography revealed high-grade small bowel obstruction secondary to presumed ruptured appendicitis. In the operating room, an infected urachal cyst was identified with adhesions to the proximal ileum. After lysis of adhesions and resection of the cyst, the patient was subsequently discharged without further issues. Conclusion. Although rare, urachal pathology should be considered in the differential diagnosis when evaluating a patient with small bowel obstruction without prior intraabdominal surgery, hernia, or malignancy.

Prenatal vesico-allantoic cyst outcome - a spectrum from patent urachus to bladder exstrophy.

The purpose of this study is to assess the prognostic significance of a cystic vesico-allantoic communication discovered on prenatal ultrasound in terms of its effect on the developing urinary tract. Multi-institution review of prenatal screening ultrasound was performed between 2004 and 2015 to identify cases of in utero communication between the fetal urinary bladder and a cystic dilatation of the umbilical cord. Gestational age at diagnosis, perinatal evolution, and eventual urinary tract outcome are described and compared with existing literature. Five cases of cystic vesico-allantoic communication were identified on second-trimester screening ultrasound. Serial ultrasounds showed an increase in the size of the umbilical cystic component with gestational age, followed by its eventual rupture prior to delivery. All neonates had urinary leakage through the inferior portion of the umbilicus with bladder prolapse ranging from patent urachus to partial bladder exstrophy. An isolated prenatal ultrasound finding of an hourglass communication between the fetal bladder and a cyst of the umbilical cord should be considered predictive of a spectrum from patent urachus to bladder exstrophy. Given the significant ramications on the developing urinary tract, the prenatal finding of vesico-allantoic cyst warrants referral to a high-risk obstetrical center with urologic consultation.

Patent Urachus Presenting as Acute Abdomen

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.

Iatrogenic tracheal rent in a Clydesdale colt

A one-month-old Clydesdale colt presented for bilateral scrotal hernia and a patent urachus. Manual reduction of the hernia followed by castration and primary closure of the superficial inguinal rings bilaterally...

Massive pyuria as an unusual presentation of giant infected urachal remnant in a child

Urachal remnants (URs) are manifestations of an incomplete regression of the urachus; therefore, there may be different types of remnants such as cyst, sinus tract, diverticulum or patent urachus. The clinical presentation of a urachal anomaly includes umbilical discharge, lower abdominal pain and urinary tract infection, although a UR may also be asymptomatic. We present the case of a 2.5-year-old girl who presented with abdominal pain, stranguria and massive pyuria in which a giant infected UR was found. The diagnosis was made using abdominal MRI. The child was subjected to laparoscopic-assisted drainage and had an uneventful postoperative course. Keywords : differential diagnosis, infected urachal remnant, laparoscopy, pyuria

A Sigmoid-Urachal-Cutaneous Fistula after Acute Diverticulitis

The urachus is an embryonic remnant of communication between the bladder and the umbilicus; it usually obliterates and becomes a fibrous cord, but the incomplete obliteration or partial recanalization leads to the development of anomalies such as urachal cyst or patent urachus. As a consequence of the diverticulitis episode, the sigmoid colon or peridiverticular abscess may adhere to the patent urachus and develop a colourachal fistula with feculent umbilical drainage. Here, we evaluated a case of sigmoid-urachal-cutaneous fistula in the light of the current literature. (JAREM 2015; 5: 83-4)