Mussan CG Torres SC, Sánchez JG, García GMA, Pérez BR, Obregón MJ

Language: Spanish
References: 15
Page: 45-48
PDF size: 164.32 Kb.

ABSTRACT

Introduction: The urachus is a vestigial fibrous cord derived from involution of the allantois that extends from the bladder apex to the umbilicus. Urachal remnant is a rare congenital anomaly, with an incidence of 1: 5000 in adults. The classic triad of the urachus pathology is umbilical secretion, abdominal pain and urinary symptoms. Traditional surgical management of benign urachal disease involves the radical excision of all anomalous tissue with or without a cuff of bladder tissue via the open approach.
Case presentation: Twenty-three year old, female patient who for the last four months has had a on and off evolution with transparent liquid leakage and afterwards purulent discharge in the umbilical scar, smelly, with hyperemia, accompanied with pain in the same region.
These episodes were treated by cleaning of the wound and antibiotics. Based on previous clinical elements, a diagnosis of urachal remnants was made and a surgical excision by laparoscopy was chosen. The patient evolved favorably and was discharged in 24 hours with no complications.
Discussion: Urachal remnants are estimated to exist in approximately 2% of adult persons, however, only few of these anomalies become symptomatic. Urachal sinus is the most frequent variant, found in 50-60% of cases. Urachal cyst is encountered in 20-40% of cases, leaving patent. Urachus the least common anomaly accounting for 15-20% of cases. Our case is thus a remainder that congenital disorders may occasionally be encountered in adult urology. The case further highlights that a non-invasive surgical approach such as laparoscopic technology is well feasible with the benefits of minimal invasive surgery.

REFERENCES

1. Navarrete A, Sánchez I. Treatment of urachal anomalies: a minimally invasive. Surgery technique. JSLS 2005; 9: 422-425.

2. Berman SM, Tolia BM, Laor E. Urachal remnants in adults. Urology 1998; 31: 17-19.

3. Blichert-Toft M, Koch F, Nilsen OV. Anatomic variants of the urachus related to clinical appearance and surgical treatment of urachal lesions. Obstetrics 1973; 37: 51-54.

4. Blichert-Toft M, Nielsen OV. Diseases of the urachus simulating intraabdominal disorders. Am J Surg 1971; 122: 123-128.

5. Busati W, Ros C, Vacarro F, Lisboa J, Souto C. Carcinoma de uraco. Rev Bras Cancerol 1992; 38: 71-73.

6. Stone NN, Garden R, Weber H. Laparoscopic excision of a urachal cyst. Urology 1995; 45: 161-164.

7. Hasson H. A modified instrument and method for laparoscopy. Am J Obstet Gynecol 1971; 110: 886-887.

8. Cadeddu JA, Boyle KE, Fabrizio MD, Schulan PG, Kavoussi LR. Laparoscopic management of urachal cysts in adulthood. J Urol 200; 165: 1526-1528.

9. Spataro RF, Dais RS, McLachlan MSF, Linke CA, Barabric ZL. Urachal abnormalities in adult. Radiology 1983; 149: 659-663.

10. Bauer SB, Retik AB. Urachal abnormalities and related umbilical disorders. Urol Clin North Am 1978; 5: 195-211.

11. Hammond G, Yglesias I, Davis J. The urachus its anatomy and associated fasciea. Anat Rec 1941; 80: 271-273.

12. Siegel JK, Winfield HN, Valderrama E, Smith AD. Laparoscopic excision of a urachal cyst. J Urol 1994; 151: 1631-1633.

13. Pust A, Ovenbeck R, Erbersdobler A, Dieckmann K. Laparoscopic management of patent urachus in adult man. Urol Int 2007; 79: 184-186.

14. Tronasen E, Reiertsen O, Rosseland AR. Laparoscopic excision of urachal sinus. Eur J Surg 1993; 159: 127-8.

15. Takatsugu O, Akihiro O, Kikuo N, Eiji H. Laparoscopic management of urachal remnants in adulthood. Int J of Urol 2006; 13: 1466-1469.