7th İnternatıonal Zeugma Conference on Scıentıfıc Researches, Gaziantep, Turkey, 21 January 2022, pp.23-24
INFECTED URACHAL CYST DIAGNOSED AT ADULT AGE: PRESENTATION OF OUR SURGICAL APPROACH ACROSS OUR CASES
At the beginning of intrauterine life, there is a urachus connection between the allontois sac and the bladder. During late fetal development or early infancy (<6 months), the urachus obliterates into a fibrous band called the median umbilical ligament. If urachal obliteration does not occur, four different embryological malformations known as urachal fistula, urachal cyst, urachal sinus, and urachal diverticulum may occur. Rarely, urachal remnants may not be recognized until adulthood. Urachal cyst can mimic acute appendicitis, Meckel's diverticulum or incarcerated hernia and can be confused with acute abdomen. Diagnosis can be made with imaging methods and it can be diagnosed and treated without creating findings such as abscess, sepsis or fistula.
Our cases were two female patients aged 20 and 28 years. Our first patient, a 28-year-old female patient, presented with an abscess formation of approximately 5-6 cm in the inferior of the umbilicus. The other patient has a history of appendectomy operation 7 years ago. She admitted to hospital with the complaint of intermittent fluid discharge from skin below the umbilicus. In the abdominal computed tomography of both patients, an infected urachus cyst was detected in the inferior of the umbilicus, behind the rectus muscles. Antibiotherapy was started in both patients. The patients had leukocytosis. An abscess drainage catheter was inserted in one patient. However, the clinical picture did not regress. In the other patient, there was no abscess that could drain after antibiotic treatment. The patients were operated. In both patients, the urachal cyst was completely excised. Perop bladder injury developed in one patient and primary repair was performed. No malignancy was observed in pathological examinations, and when evaluated together with the clinic, it was reported as an infected urachal cyst. The patients were discharged with good recovery after postoperative follow-up.
In conclusion, infection due to urachal cyst is a rare condition in adults. Umbilical discharge should be considered in the presence of a mass or abscess formation that may occur under the umbilicus and in the midline. Although abscess drainage and antibiotic therapy can be used in its treatment, total excision should be performed due to the risk of malignancy.
Key words: infected urachal cyst, surgical approach, adult urachal cyst