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Urachal cyst is a clinical malformation caused by failure of the allantois to obliterate during embryological development. Because of its rare presentation in adults, urachal cysts are often incorrectly diagnosed. Delay in diagnosis can cause complications such as peritonitis, fistula, sepsis, or even malignant manifestation. We report the case of a 19-year-old adult male, who presented with clinical features mimicking appendicitis. Ultrasound and magnetic resonance imaging confirmed diagnosis of an infected urachal cyst, which was treated surgically., (© 2024 The Author(s). Journal of Clinical Ultrasound published by Wiley Periodicals LLC.)

Rationale: Urachal anomalies are rare and can present with various clinical manifestations. Urachal remnants, in particular, can be difficult to diagnose because of atypical symptoms at presentation. This study reports a case of intestinal obstruction in an infant secondary to an infected urachal cyst., Patients Concerns: A 3-month-old boy with a known febrile urinary tract infection developed acute abdominal distension., Diagnoses: Abdominal ultrasound (US) and computed tomography (CT) revealed a nonspecific, ill-defined soft tissue density at the mid-abdomen, associated with intestinal obstruction., Interventions: Emergency exploratory laparotomy was performed. The site of the obstruction was found to be at the mid-small bowel; the proximal small bowel was markedly distended, and the small bowel and sigmoid colon were adherent to urachal remnant. The urachal remnant was excised, and the peritoneal adhesions were lysed., Outcomes: The day after surgery, the patient was discharged without any complications., Lessons: Intestinal obstruction is an exceedingly rare presentation of urachal remnants. This case highlights that urachal anomalies should be considered in the differential diagnosis in patients with intestinal obstruction and a concurrent febrile urinary tract infection., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: The vesico-allantoic cyst is a communication between the fetal bladder and the allantois through a patent urachus. Case Report: We describe a 17-week of gestational age (WGA) fetus with a 40 x 30 mm vesico-allantoic cyst. At 19 WGA, ultrasound (US) detected bilateral dilatation of renal pelvis (5-6 mm), hydroureters, and hypospadias. Amniotic fluid, umbilical cord flow, and fetal biometry were regular. Due to uncertain prognosis, the parents opted for legal termination of pregnancy. Autopsy confirmed the prenatal findings, also revealing intestinal malrotation and Meckel's diverticulum. Discussion/Conclusion: Probably an initial urinary tract obstruction occurred, not yet affecting the amniotic fluid volume, but evident as pyelectasis. This case highlights the possibility that genito-urinary and intestinal anomalies may be found in association with the vesico-allantoic cyst.

Background: A urachal cyst has a rare incidence that has been reported as 1/5,000 live birth., Case Presentation: We report two patients with a complicated urachal cyst, a 5-year-old female who presented to the emergency department with severe abdominal pain and a 3-year-old female presenting with abdominal pain and constipation. Upon laparoscopic exploration both patients had complicated urachal cysts which were adherent to the urinary bladder., Conclusion: Complicated urachal cysts can present with acute abdominal pain., (© 2023. The Author(s).)

A 37-year-old male presented to the emergency department with the complaint of periumbilical abdominal pain, radiating to just above pubic symphysis. The patient reported that the pain was worse with urination and associated with chills and nausea. This case reports discusses the Emergency Department (ED) course and subsequent treatment of a patient found to have an infected urachal cyst, a previously asymptomatic embryological anomaly in an otherwise healthy middle-aged adult male. This is a crucial diagnosis to make in order to avoid the potential for significant morbidity and/or mortality, given the unlikely symptomatic source., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

The urachus is a remnant of the allantois. Failure to obliterate can result in one of four anomalies, urachal cyst being most common. Urachal cysts are relatively rare, especially in adults. This paper presents a patient with an umbilical hernia and a ruptured urachal cyst. A 39-year-old male presented with concern for umbilical hernia, but he also noted drainage. Computed tomography scan showed a urachal cyst and umbilical hernia. The urachal cyst was excised and umbilical hernia closed primarily. The incidence of an urachal cyst is unknown, but persists in roughly 2% of adults. Diagnosis is with ultrasound or CT scan. Management is excision due to risk of urachal carcinoma, which is present in over 50% of specimens. Review of literature did not reveal any other cases of a patient with both an urachal cyst and an umbilical hernia, thus making this case a unique presentation for this condition.

Background: Eosinophilic cystitis is a rare inflammatory disease of the bladder characterized by eosinophilic infiltration of the bladder wall. Most Eosinophilic cystitis cases present with mucosal lesions of the urinary bladder. We present a very rare case of large mass-forming eosinophilic cystitis, involving the inside and outside of the bladder associated with an infected urachal cyst., Case Presentation: A 59-year-old man presented with gross hematuria, fever, dysuria, and suprapubic pain. Computed tomography showed a heterogeneously enhancing mass that measured 7.6 cm × 4 cm located on the anterosuperior portion of the bladder with an internal fluid collection. Cystoscopy revealed a raspberry-like mass lesion on the bladder dome. Transurethral resection of the bladder was initially performed. The mass lesion protruding from inside the bladder was removed, and pus-like fluid was drained. The pathologic diagnosis was eosinophilic cystitis. Follow-up computed tomography showed a remnant mass outside the bladder and urachal cyst. To eliminate the remnant lesion, robot-assisted partial cystectomy was performed. The patient showed no evidence of recurrent disease on follow-up cystoscopy and computed tomography for up to 2 years., Conclusions: Clinicians should consider the possibility of eosinophilic cystitis in patients who present with hematuria, fever, and suprapubic pain and have both intravesical and extravesical masses., (© 2021. The Author(s).)

Introduction: Urachal cyst is an exceptionally rare disease in children caused by the incomplete obliteration of the urachal remnant. Urachal cysts seldom cause symptoms unless a secondary infection occurs. The symptoms of an infected urachal cyst are nonspecific and may be similar to acute appendicitis or other acute abdominal conditions. However, complications attributable to a delayed diagnosis can endanger the life of a patient., Patient Concerns: A 5-year-old boy presented with a 3-day history of severe intermittent lower abdominal pain., Diagnosis: Infected urachal cyst., Interventions: The patient was treated with surgical resection of the urachus, followed by intravenous antibiotics during the hospitalization., Outcomes: The patient was discharged without incident 7 days after the operation. With his follow-up in our out-patient department, he recovered well without any sequelae in the 6 months post-surgery., Conclusion: We suggested using the abdominal echo scan to differentiate the urachal cyst because of its high sensitivity and nonradioactive characteristic, and computed tomography is a typical diagnostic tool for urachal cysts. The mainstream management of an infected urachal cyst remains surgical excision. Complete excision of urachal cysts is relatively easy in a pediatric patient and the risk of subsequent infection is low; however, patients tend to have a low, although possible, risk of potential malignant transformation over their lifetimes.

Background: Rare causes of abdominal pain include abnormalities of the urachus, including patent urachus and urachal cyst with or without infection. However, reviews discussing etiology of abdominal pain, even in children, may completely omit mention of urachal remnants., Objectives: Determine the incidence of symptomatic urachal remnants in patients presenting to the emergency department (ED), including common presenting findings and method of diagnosis., Methods: A retrospective chart review was performed of all patients presenting to the ED with abdominal pain who were diagnosed with urachal remnants, including patent urachus or urachal cyst or abscess over a period of 11 years and 7 months in one hospital., Results: There were a total of 833,317 ED visits over the time period of the chart review, with 76,954 patients or 9.2% presenting with a complaint of abdominal pain. Twenty-four patients were identified, or 0.03% of those presenting with abdominal pain. Ages ranged from 16 days to 59 years. Among those 18 years or older, there was a male-to-female ratio of 1:1 of 14 patients. Thirteen patients (54.2%) initially presented with drainage from the umbilicus., Conclusions: Although rare, symptomatic disorders of urachal remnants may present at any age. These disorders should be kept in mind by the emergency physician among the broad list of differential diagnoses accounting for abdominal pain. Urachal cyst and abscess may present with or without drainage from the umbilicus. Drainage from the umbilicus is highly suggestive, but not pathognomonic, of a urachal anomaly, and patients should be imaged to make a definite diagnosis and assist in the management plan., (Copyright © 2018 Elsevier Inc. All rights reserved.)

An 18-year-old male presented in the emergency department with abdominal pain since two days and complaints of pollakisuria. Laboratory results showed increased infection parameters and ultrasound revealed an abscess in the abdominal lower right quadrant. The patient underwent diagnostic laparoscopy. We found an infected cyst, most likely an infected urachal remnant considering its location and the histological findings in the resected tissue.

A 26-year-old pregnant woman was diagnosed with fetal bladder prolapse following rupture of a patent urachus/urachal cyst, based on the finding of cyst disappearance with replacement with an infra-umbilical, extra-abdominal solid soft-tissue mass, mimicking bladder exstrophy. The neonatal findings confirmed the prenatal diagnosis. The baby was healthy and had a successful surgical correction. This report provides clues to differentiating ruptured bladder prolapse from bladder exstrophy as follows: (1) well-documented urachal cyst with urine-filled mass in the early gestation, (2) development of solid soft-tissue mass shortly after disappearance of the urachal cyst, and (3) no other structural abnormalities (bladder exstrophy is usually associated with abnormal genitalia, epispadias, or pubic diastasis). This study underlines the differentiation between the two entities because of the vast difference in prognosis, management, and proper counseling.

We present the case report of a preterm infant with delayed umbilical cord separation. At the age of four weeks the umbilical cord separation had still not occurred. The umbilical cord tissue sometimes seemed wet and did not dry completely. There were no signs of immunodeficiency. An ultrasound of the abdomen showed a small urachal cyst. No further intervention was indicated.

Objective: To establish whether the urothelial ulceration observed in ketamine-induced cystitis is triggered by urinary or systemic factors. This was achieved with a rare case where an urachal cyst was found near the bladder dome in a patient undergoing cystectomy for unremitting pain following ketamine abuse., Methods: Clinical investigations included cystoscopy, video urodynamic investigation, and computed tomography of the kidneys, ureters, and bladder. Histological staining was combined with immunoperoxidase labeling for markers of transitional epithelial differentiation., Results: The urachus found near the dome of the bladder was observed to be a separate cyst, with no evidence of patency found during surgery or video urodynamic investigation. The urachus was lined by a mildly reactive metaplastic epithelium of mixed transitional and columnar morphologies. Evidence of widespread cytokeratin 13, basal p75(NTR), and sparse superficial uroplakin 3a immunoreactivity suggested the urachal epithelium was fundamentally transitional in nature. Near total loss of bladder urothelium was observed from regions in contact with urine, whereas the urachal epithelium (not exposed to urine) remained healthy., Conclusion: This study supports the hypothesis that urinary (and not systemic) factors are the main driver of urothelial ulceration in ketamine-induced cystitis. The most likely excreted factors responsible are ketamine and potentially its metabolites. This study reinforces the importance of complete cessation of ketamine use in patients with ketamine-induced cystitis., (Copyright © 2016 Elsevier Inc. All rights reserved.)

The urachus is a tubular structure extending from the dome of the bladder to the umbilicus. Normally, this allantoic and cloacal remnant obliterates into a fibrous band by late fetal development. Urachal abnormalities include a patent urachus, urachal cyst, umbilical urachal sinus, and a vesicourachal diverticulum. These abnormalities are most often asymptomatic and only come to clinical attention when associated with infection. A 2-month-old male infant presented to our tertiary pediatric hospital with several days of intermittent fevers and a focal region of swelling and erythema over the umbilicus. On physical examination, a tender mass was palpated in the umbilical region. Ultrasound revealed a long tubular structure coursing from the dome of the bladder anteriorly and superiorly to the subumbilical region. This tubular structure was fluid filled with internal echoes suggestive of infection with abscess formation. The urachal abscess was drained surgically, at which time a patent urachus was also excised. This case demonstrates the importance of having a thorough understanding of urachal anomalies when evaluating infants presenting with umbilical pathology.

Urachal anomalies are relatively uncommon and result because of incomplete obliteration of the urachus prenatally. In children, urachal cysts and sinuses constitute the common presentations, and these can sometimes become secondarily infected. Malignant involvement of the urachus in the pediatric population is rare, and primary urachal adenocarcinoma is reported exclusively in adults. Herein, we present the case of an adolescent girl with a low-grade mucinous neoplasm arising in a urachal cyst and discuss its significance., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: during gestation, the urachus represents the connection between the dome of the bladder and the allantoic duct. This infection occurs preferentially in young adults, advocating the haematogenous or lymphatic pathway as possible routes of transmission, while a cord or bladder origin may also occur. Urachal cysts are rare in adult life, and is observed in only about 2% of adults., Clinic Case: A 30-year-old male patient with a history of alcoholic hepatitis, diabetes mellitus type 2, chronic malnutrition, increased volume beginning with generalized abdominal pain, abdominal tumor of 20 by 15 cm, mobile, solid, without signs of peritoneal irritation. CT showed the presence of tumor, probably bladder-dependent, and apparently cystic. Exploratory laparotomy was found infected urachal cyst, draining 3,000 cc purulent material. A partial resection of the anterior face, keeping the back by firm adherence to bowel loops was done and is evolving satisfactorily., Discussion: urachal abnormalities are rare, with male / female ratio of 2 / 1. Although urachal abscess is an infection confined to an enclosed space, definitive treatment should not be the simple incision and drainage, because of the possibility of malignant transformation of urachal remnants. The definitive treatment should be considered complete excision of urachal cyst, when the infection is limited., Conclusion: the urachus cyst is a rare pathology and is a diferencial diagnosis for acute appendicitis and it is necessary to know this treatment.

An 18-year-old female patient with Crohn's disease had abdominal pain secondary to a retained pill camera. After several weeks of medical management, the camera spontaneously passed. However, the patient also had an intra-abdominal abscess that worsened, despite medical therapy. Surgical therapy was recommended and a 5cm infected urachal cyst with entero-urachal and vesico-urachal fistulas was discovered. An en-bloc resection of the entire area was performed to include the urachal cyst, the adherent portion of the dome of the bladder, and 15cm of associated ileum. The bladder was repaired, a suprapubic catheter was placed, and an ileo-ileal anastamosis was performed. Microscopic findings were consistent with active Crohn's disease and fistula formation. The entero-uracho-vesical fistula site was likely the site of the retained pill camera. The patient did well postoperatively and was discharged on postoperative day six without complications.

Urachal cysts present very uncommonly in adults. We describe a 25-year-old man who attended with a discharging umbilical swelling and pain. Ultrasonography and CT scan demonstrated an infected urachal cyst which, following cystoscopy, was excised without complication.

A 10-month-old Brown Swiss heifer was referred to our clinic be- cause of pollakiuria, stranguria and tenesmus. Ultrasonography and endoscopy revealed a cyst-like lesion at the apex of the urinary bladder. The apex of the bladder was surgically removed with the patient in dorsal recumbency under general anaesthesia. Histological examination revealed a cyst lined with urothelium in the wall of the urinary bladder. The heifer was discharged 9 days after surgery. According to the owner's information the animal did not show any clinical signs 6 months later.

Enterourachal fistulas are exceedingly rare in Crohn's patients. We report a case of a presumed enterourachal fistula that led to an infected urachal cyst. Preoperative medical treatment obliterated the fistula and avoided the need to resect bowel at the time of operation. We recommend consideration of this diagnosis in a Crohn's patient with a midline abdominal mass., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: To analyze the multislice spiral computer tomography (MSCT) manifestations and its value in the diagnosis of urachus lesions., Methods: A total of 26 patients with urachus disease diagnosed by pathological examination in our hospital between October 2007 and May 2011 were included in this study. We retrospectively analyzed MSCT images on the size, location, and shape character of the foci, and the image features of Retzius space., Results: In the group, 12 patients had simple urachal cyst with homogeneous fluid filling the cavity with thin wall in CT scanning; five had infected urachal cyst with thickened and enhanced wall, some patch and strip appearing in Retzius space surrounding the lesion; two had infected urachal sinus, and another 3 had urachus leakage. Four had urachal tumor showing irregular cysticsolid mass over the apex of the bladder with apparent enhancement in contrast imaging, and 2 had calcification. Invasion of the bladder wall was found in 4 patients, extensive invasion of the ileum, rectum, uterus and retroperitoneal lymph nodes was found in 1., Conclusion: MSCT scan can demonstrate the location, shape, extent of the lesion as well as the relation with adjacent structures, thereby providing valuable information for the diagnosis and differential diagnosis of urachus lesions.

Background: The urachal cyst is a rare pathology in the adult patient and in general is asymptomatic. The goal of this presentation is to learn of the errors., Clinical Case: A 22 year old female with clinical diagnosis of acute appendicitis was taken to surgical management. Laparoscopy confirmed the diagnosis. Laparoscopic appendectomy was performed uneventfully. Four weeks in the postoperative period the patient developed reddening and softening in the left surgical wound which was a trocar incision. The initial diagnosis was a granuloma which was removed surgically twice. A fistulogram and abdominal CT scan were negative. Finally, we decided to perform a laparatomy trought the same incision and we found an infected urachal cyst, which was excised. A retrospective analysis of the laparoscopic appendectomy shows the urachal cyst and the perforation by the trocars., Conclusion: an inadequate process in the laparoscopic vision, in the diagnosis and technical errors were the cause of this chain of errors and a major temporal damage to this patient. An optimal laparoscopy would have detected the urachal cyst and treated of the two pathologies simultaneously. An adequate trocar placement would not have perforated the urachal cyst and therefore there would have been no postoperative symptoms. Finally open appendectomy could have avoided this chain of errors.

Unlabelled: A 2-year-old girl who presented with acute abdominal pain and spiking fever was diagnosed with an infected urachal cyst. Ultrasonography aided the diagnosis and the urachal remnant was removed successfully through a single laparoscopic procedure. Treatment is through removal of the complete structure, to prevent malignant degeneration in adulthood., Conclusion: Urachal cysts may cause abdominal complaints when infected. Although rare, they should be added to the differential diagnosis of acute abdominal pain in the paediatric patient, as this case illustrates.

The urachal cyst is a rare clinical entity of a urachal remnant. It is usually asymptomatic but can present with haematuria, tumour, urachal stone and infection. We present a case of a 63-year-old lady with a body mass index (BMI) of 49 who presented with a painful swelling in the umbilical region associated with an umbilical hernia. An ultrasound and computed tomography (CT) scan showed a suspected herniation of an umbilical remnant cyst through a paraumbilical defect. Laparoscopy confirmed the urachal cyst of 3 cm in size with a band connected with the cyst down to the urinary bladder associated with a 3-cm paraumbilical hernia. We removed the cyst and repaired the hernia laparoscopically uneventfully, after which her recovery was perfect. Radiological and laparoscopic pictures have not been reported in the English literature before. Although this condition is very rare, we suggest that it should be considered in the differential diagnosis of painful paraumbilical swelling. CT scanning and laparoscopy seems to be valuable, especially in obese patients.

Urachal cysts are usually asymptomatic. Symptoms, when present, are usually acute abdominal pain, fever, midline hypogastric tenderness, palpable mass, evidence of urinary infection or haematuria due to infection of the cyst. We report an unique case of dyspareunia and "abdominal fluid flowing feeling" caused by an urachal cyst in a 28 year-old nulliparous woman. Diagnosis was achieved by US and MRI. Cystography excluded any cyst-bladder communication. Laparoscopic surgery was performed without perioperative complications. Patient obtained immediate relief of symptoms still continuing at a 24 months follow up.

Urachal cyst complications requiring surgical intervention are rarely seen in adults, because the urachus is normally obliterated in infancy. Necrotizing fasciitis due to an infected urachal cyst in an adult female has not been reported. We describe the case of a fifty-year-old female who required aggressive surgical management of abdominal wall necrotizing soft tissue infection from an infected urachal cyst.

Objectives: This study was carried out to determine the prognosis, and the clinical approach, in fetuses with umbilical cord cysts, during the second and third trimesters of gestation, according to our experience and data in the current literature., Methods: We identified 10 fetuses with umbilical cord cysts that were diagnosed during the second and third trimesters of pregnancy at three referral centers. All underwent detailed ultrasound evaluation at the time of diagnosis and during follow-up. Prenatal karyotype testing was offered to all women. A MEDLINE review of the literature published from 1980 to 2009 was carried out to identify previous studies and case reports of fetuses with umbilical cord cysts., Results: In our series of 10 cases, significant additional abnormalities were observed in two during a detailed sonogram. In one case, trisomy 18 was diagnosed, leading to pregnancy termination, and in the other case a neonate with heart defects and a normal karyotype was born. These results differ from those reported in the literature, in which the association between second- and third-trimester umbilical cord cysts and fetal anomalies ranged from 38 to 100%., Conclusions: In our study, as in other publications, an association was found between the presence of second- and third-trimester umbilical cord cysts and fetal anomalies. The strong association between second- and third-trimester umbilical cord cysts and aneuploidy in the literature seems to be biased, mainly because of the tendency to report abnormal cases. When these findings are accompanied by additional sonographic abnormalities, the association with aneuploidy is clear and should be an indication for fetal karyotype testing., ((c) 2010 ISUOG. Published by John Wiley & Sons, Ltd.)

Normally, the urachus is obliterated at the latest in early infancy and degenerates to a fibrous band extending from the bladder to the umbilicus. Urachal anomalies may develop through an absent or incomplete obliteration, which more commonly cause clinical problems in children. Urachal cysts (UC) represent the most common form in adulthood. They most likely remain asymptomatic until complications occur. We report the case of a 32-year-old man with abscess formation in the abdominal wall as a complication of an infected ruptured UC.

Objective: The purpose of this series was to report the first-trimester sonographic findings, antenatal course, and outcome in fetuses with a patent urachus., Methods: We conducted a review of ultrasound reports and medical charts from 3 pregnancies complicated by a congenital patent urachus detected in the first trimester., Results: All 3 fetuses had megacystis and an umbilical cord cyst close to the fetal abdominal insertion that was detected in the first trimester. In 2 cases, the megacystis resolved spontaneously while the umbilical cord cyst worsened in appearance; among them, massive edema of the umbilical cord was documented in 1, and evidence of partial bladder exstrophy was detected in the third trimester in the other. Both cases required neonatal surgery with no complications. In the remaining case, the fetus died in the early second trimester. Postmortem examination confirmed the diagnosis of a patent urachus, an allantoic cyst, and thrombosis of the umbilical vessels., Conclusions: Megacystis is a warning sign of a patent urachus in the first trimester. The prognosis of this condition is generally good; however, fetal death can occur secondary to compression of umbilical vessels due to the expanding allantoic cyst.

Objectives: We report a case of urachal remnant disease and review the literature., Methods/results: We present the case of an urachal cyst in a 13-year-old patient who was admitted to the emergency department with acute abdominal pain. Differential diagnosis of his symptoms was made with other diseases such as appendicitis and inflammatory bowel disease., Conclusions: Urachal remnant diseases are rare and they usually present during the neonatal period with fever and wet navel, lower abdominal pain around the middle line, palpable mass and urination symptoms with or without urinary infections. The presentation as acute abdominal pain in an older child is less common, and its differential diagnosis must be performed with other abdominal or pelvic acute diseases. The most appropriate imaging technique is an ultrasound exam.

Objective: To report one case of appendiceal mucocele misdiagnosed with an infected urachal cyst and to review their differential diagnosis, treatment and prognosis., Patient: We report the case of a 74-year-old-male with abdominal pain, fever and dysuria. Hypogastric abscess image in ultrasonography and CT. Percutaneous drainage and antibiotic therapy. Opaque enema, colonoscopy and cystoscopy were normal., Results: Exploratory laparotomy and resection of a large cecum-fixed mass, independent to the bladder. Appendectomy and cecectomy. Pathology showed an appendiceal mucinous cystoadenoma (mucocele)., Conclusions: Appendiceal mucoceles and urachal cysts are uncommon, mostly asymptomatic. Cystoadenoma or cystoadenocarcinoma mucoceles are large and can reach the midline, confounding with urachal cysts. Diagnosis by ultrasonography and/or CT. Surgical treatment in both, keeping the mucocele intact during operation to avoid the risk of pseudomyxoma peritonei.

Introduction: The clinical manifestation of urachal abnormalities may mimic many intraabdominal or pelvic diseases. We present clinical, imaging and pathological findings of a spectrum of complicated urachal abnormalities and determine whether imaging can be used to differentiate tumour from infection., Methods: From January 1993 to December 2006, seven patients with surgically-proven complicated urachal abnormalities had their clinical, imaging and pathological features reviewed., Results: There were three men and four women, aged 12-73 years. Four patients had infected urachal remnants and three had urachal carcinoma. The main clinical findings in infected urachal remnants were dysuria, abdominal pain and mass. The patients of urachal carcinoma presented with abdominal mass and haematuria. Computed tomography (CT) was performed in all cases, and ultrasonography (US) was performed in four cases. CT in all cases showed a mass located extraperitoneally in the midline just beneath the rectus abdominis muscle and extending from the umbilicus to the dome of the urinary bladder. There were one well-defined cystic mass and six ill-defined solid masses. US showed one cystic mass and three echogenic masses. Cystography was performed in one patient and it showed indentation to the dome of the urinary bladder with mucosal irregularity. The cystic mass and one ill-defined solid mass were pathologically-proven to be xanthogranulomatous inflammation. The other five solid masses were found to be adenocarcinoma in three and chronic non-specific inflammation in two cases., Conclusion: Preoperative diagnosis of urachal abnormalities may be suggested by clinical presentation and imaging features. However, it is difficult to differentiate tumour from infection based on imaging features alone.

Incomplete involution of the allantoic duct can result in different pathological forms of urachus which can give rise to inflammation or late malignant changes. Among urachal tumors, adenocarcinoma is most frequent, although other histological types can also be found. The synchronous presentation of a urachal transitional cell tumor, along with recurrent superficial bladder tumors has not been reported previously. We are reporting a 49-year-old male patient in whom transitional cell carcinoma of a urachal cyst was found with recurrent, multiple bladder tumors. The diagnosis of urachal cyst tumor was established according to ultrasonography and computed tomography. Most of the bladder tumors were resected transurethrally while open surgical excision of the urachal cyst with en bloc resection of the bladder dome was performed. Recurrent bladder tumors were afterwards treated with Bacillus Calmette Guerin (BCG) instillations. A year after surgery the patient has no signs of local recurrence or distant metastases of transitional cell carcinoma.

Etanercept, a tumor necrosis factor (TNF) receptor alpha antagonist is licensed for the treatment in patients affected by polyarticular juvenile idiopathic arthritis, who do not tolerate or had an inadequate response to methotrexate. Infections related to immunosuppression by etanercept are of major concern. We report on a 17-year-old boy with enthesitis-related arthritis who developed a major infection of an urachal cyst 18 months after initiation of etanercept therapy, which required surgery. The urachus had not been symptomatic before.

Urachal cysts are rare, can be one of the forgotten causes of abdominal pain, and can present as adenocarcinoma of the bladder, along with many other presentations. There is a real need for physicians, general surgeons, and urologists to be acquainted with the different presentations and management of this rare condition.

A rare occurrence of an omphalomesenteric duct cyst in an exomphalos minor sac is reported herein. The noteworthy points in this case were an unusual presentation of the rarest variety of umbilical cord cyst. The tapering intra-abdominal end of the cyst was found to be attached to the ileal mesentry, thereby simulating a herniating mesenteric cyst till the histolopathological report resolved the issue.

The urachus is a midline tubular structure that extends upward from the dome of the bladder toward the umbilicus. This tubular structure normally involutes before birth, remaining as a fibrous band with no known function. Persistence of all or any portion of the fetal urachus results in several anomalies, the most common of which is the urachal cyst (Yu JS, Kim KW, Lee HJ, Lee YJ, Yoon CS, Kim MJ, Radiographics, 21:451-4611, 2001; Ohgaki M, Higuchi A, Chou H, Takashina K, Kawakami S, Fujita Y, Hagiwara A, Yamagishi H, Surg Today, 33:75-77, 2003). Although most urachal cysts are asymptomatic, there are a few reports about intraperitoneal rupture of infected urachal cysts, all of which caused peritonitis and sepsis (Ohgaki M, Higuchi A, Chou H, Takashina K, Kawakami S, Fujita Y, Hagiwara A, Yamagishi H, Surg Today, 33:75-77, 2003; Kojima Y, Miyake O, Taniwaki H, Morimoto A, Takahashi S, Fujiwara I, Int J Urol, 10:174-176, 2003; Agatstein EH, Stabile BE, Arch Surg, 119:1269-1273, 1984). We report the imaging and operative findings of a patient, presented with a urachal abscess after a spontaneously ruptured urachal cyst.

Urachal cysts are congenital anomalies detected predominantly during the childhood. They are often diagnosed when an infection occur mimicking a variety of acute intra-abdominal or pelvic processes. We present a case in a 7-year-old female infant, diagnosed of infected urachal cyst. The embryologic origin of this anomaly, clinical features, diagnosis and treatment are discussed.