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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. [ABSTRACT FROM AUTHOR]

Urachal cysts are conditions present at birth that usually occur in children. This disease is very rare in adults. Approximately 35% of patients present with complaints of lower abdominal pain, signs of urinary tract infection, painful lumps in the abdomen, and hematuria. Here we present a case of A 27 year old woman came to the emergency unit with a lump in her stomach since 3 months before admitted to the hospital, located in the lower abdomen, the initial lump was the size of a marble, it got bigger over time and the patient felt feverish. The lump size was the size of a fist and burst open releasing pus and blood. This patient was diagnosed using CT-scan and Ultrasonography. This patient did not undergo any treatment, and chose to go home resulting in a loss to follow up. Urachal residual disease is a rare and manifests with nonspecific abdominal or urinary tract signs and symptoms. Although rare, disorders of the urachus can take the form of acute, life-threatening infections or malignant degeneration. It is important to carry out an accurate diagnosis and appropriate treatment. Urachal anomalies are rare in adults and often undiagnosed due to their nonspecific clinical course. Early diagnosis using several modalities such as ultrasonography and CT-Scan can help in planning an appropriate surgical intervention, thereby reducing morbidity.

Bladder urachal cysts in children are a rare form of urachal abnormality. In this paper, we present a case of atypical imaging that presented with lower abdominal pain accompanied by hematuria, resulting in the formation of both internal and external urachal cysts in a child. A 6-year-old male child presented with repeated abdominal pain over a span of 4 days. Color ultrasound and pelvic CT scans revealed a soft tissue lesion on the right anterior wall of the bladder with an unclear boundary from the bladder wall. Voiding Cystourethrography (VCUG) showed no significant abnormalities in the bladder, while routine urine testing was positive for hematuria. A cystoscopy was simultaneously performed with a laparoscopic resection of the urachal cyst. Intraoperative cystoscopy identified the intravesical lesion, which was precisely removed using a cystoscope-assisted laparoscopy. Postoperative pathology confirmed that both extravesical and intravesical lesions were consistent with a urachal cyst. No complications were observed after the operation, and no recurrence was noted during a six-month follow-up. Therefore, for urachal cysts at the bladder's end, the possibility of intravesical urachal cysts should not be excluded, especially in patients with microscopic hematuria. We recommend performing cystoscopy simultaneously with laparoscopic urachal cyst removal to avoid missing intravesical lesions.

Background: The urachus is a fibrous cord that arises from the anterior bladder wall and extends to the umbilicus, degenerating after birth [1]. Urachal cysts are congenital abnormalities resulting from incomplete obliteration of the urachus into the median umbilical ligament [2–4]. The cyst often remains asymptomatic but can present with symptoms associated with urinary tract infection, abdominal pain, erythema, swelling, and hematuria [5]. When left untreated, can lead to severe complications like rupture and sepsis [6]. Definitive treatment is with excision, which can be performed via an open, laparoscopic, and robotic approach. Objective: To present a video case report of robotic-assisted excision of a urachal cyst, highlighting key takeaways for robotic surgical trainees. Methods and Materials: We report a 24-year-old previously healthy male who presents with umbilical pain for one week and drainage from the umbilicus for one day. He had a similar episode ten years ago which self-resolved within a day. CT abdomen/pelvis with contrast notable for a 1.8 cm rim-enhancing fluid collection deep to the umbilicus. Patient was treated with a course of Bactrim with resolution of his symptoms and interval imaging notable for resolution of fluid collection. Patient decided to proceed with robotic-assisted excision of urachal cyst due to recurrent infections and drainage. Results: Intra-operatively, the urachal cyst was identified and skeletonized to the level of the umbilicus and then down to the level of the bladder. The cyst was excised with a circumferential margin, and the resulting bladder defect that was closed in two layers. After the bladder was filled demonstrating no leak, the urachal cyst was removed without complication. Conclusions: Urachal cysts are a congenital anomaly that can present with a wide variety of clinical presentations [7,8]. Robot-assisted removal provides a minimally invasive technique for successful excision of a urachal cyst when indicated.

The urachus is an embryologic remnant that connects the bladder to the umbilicus and typically obliterates during gestation. Urachal cysts are one of the most common congenital urachal anomalies. Urachal cysts may be found incidentally on imaging or present as a palpable mass with abdominal pain and fever. We present a case of a young male with a urachal cyst who presented with lower urinary tract symptoms and a falsely elevated post void residual (PVR) volume on bladder scan. This case illustrates an atypical presentation of a large urachal cyst and highlights the limitations of bladder scanner post-void residual determination.

CASE PRESENTATION: A seven-year-old male presented to the pediatric emergency department with one day of abdominal pain. His physical exam was significant for rebound, guarding, and tenderness in the right lower quadrant, and his labs demonstrated a leukocytosis. Both a point-of-care ultrasound and radiology-performed ultrasound were concerning for acute appendicitis with a periappendiceal abscess, but on emergent laparoscopy the patient was found to have an infected urachal cyst.DISCUSSION: Infected urachal remnants are a rare but important cause of pediatric abdominal pain. In this case, inflammation surrounding the patient’s midline urachal cyst triggered a serositis that involved the appendix and pulled the cyst to the right. This created a clinical and radiologic presentation similar to appendicitis. This atypical presentation of an already rare anomaly highlights the importance of maintaining a broad differential during the work-up of pediatric abdominal pain.

The urachus is a tubular structure that is apparent on the third week and connects the ventral cloaca to the yolk sac, as a progression from the allantois. Following the normal regression procedure, the urachus remains as the median umbilical ligament. Urachal remnants are present in 1.03% of paediatric patients while in 92.5% of cases represent incidental findings. Urachal anomalies are classified in four types as patent urachus (50-52%), urachal sinus (15%), urachal cyst (30%) and urachal diverticulum (3-5%). Ultrasound scan is the most commonly performed diagnostic imaging study. In case of symptomatic urachal remnants, surgical excision is indicated. Asymptomatic urachal remnants that are diagnosed at the neonatal period or early infancy should be watched up to 6 months of age, as they are likely to resolve. In persistent or symptomatic urachal remnants there is a risk of inflammation or even malignancy development, therefore we believe that there is indication for preventive surgical excision that may be performed either open or laparoscopically or by robot-assisted laparoscopy. [ABSTRACT FROM AUTHOR]

Abstract Background Abnormalities of the urachus include the patent urachus, cysts, sinus, and fistula. Each of these entities represents a failure of complete obliteration of the urachus. Contrary to other urachus anomalies, urachal cysts are usually small and silent unless they are infected. The diagnosis is often made during childhood. A benign noninfected urachal cyst discovered in adulthood is a rare condition. Case presentation Herein we report two cases of benign noninfected urachal cysts in adults. The first case is a 26-year-old Tunisian white man who presented with complaints of clear fluid draining from the base of the umbilicus evolving for a week, with no other associated symptoms. The other case was 27-year-old Tunisian white woman who was referred to the surgery department with a history of intermittent draining of clear fluid from the umbilicus. The two cases had laparoscopic resection of urachus cysts. Discussion Laparoscopy represents a good alternative for the management of persistent or infected urachus, especially when this is suspected, despite a lack of radiological evidence. Laparoscopy in the management of urachal cysts is safe, effective, and offers good cosmesis, with all the advantages of a minimally invasive approach. Conclusion Managing persistent and symptomatic urachal anomalies requires a wide surgical excision. Such intervention is recommended to prevent symptom recurrence and complications, most notably malignant degeneration. A laparoscopic approach offers excellent outcomes, and is recommended to treat these abnormalities.

Abstract 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.

Aim: To report our experience in the laparoscopic management of symptomatic urachal remnants (URs) in adults. Patients and Methods: A retrospective study included all patients who underwent laparoscopic excision of URs during the period January 2015–January 2020. The following data were retrieved from the files of the patients: demographic data, clinical presentations, intra-operative findings, the procedure performed, operative details, intraoperative or post-operative complications and follow-up period mentioned in the files for those patients. Results: The study included 10 patients (four males and six females) with a mean age of 27.8 ± 11.0 years. URs were discovered preoperatively in all patients except one patient who was diagnosed intraoperatively. URs were associated with other pathologies in four patients (40%) that required two simultaneous surgical procedures. Eight patients (80%) presented with simple umbilical discharge and were diagnosed easily by ultrasonography. All patients were managed successfully with laparoscopic excision and umbilical sparing technique. Excision of the dome of the bladder was done on the selective approach to one patient. No patients showed early post-operative complications. Only one patient had stitch sinus 6 months postoperatively due to a concomitant hernia repair rather than due to the excision of the URs. Conclusions: Laparoscopic excision of symptomatic urachus is a feasible procedure even when the excision of the bladder is required. It could be performed successfully with other pathologies. It is associated with a low incidence of complications. Laparoscopy allows good visualisation and complete excision that leads to almost no recurrence rate.

Background: Abnormalities of the urachus include the patent urachus, cysts, sinus, and fistula. Each of these entities represents a failure of complete obliteration of the urachus. Contrary to other urachus anomalies, urachal cysts are usually small and silent unless they are infected. The diagnosis is often made during childhood. A benign noninfected urachal cyst discovered in adulthood is a rare condition. Case presentation: Herein we report two cases of benign noninfected urachal cysts in adults. The first case is a 26-year-old Tunisian white man who presented with complaints of clear fluid draining from the base of the umbilicus evolving for a week, with no other associated symptoms. The other case was 27-year-old Tunisian white woman who was referred to the surgery department with a history of intermittent draining of clear fluid from the umbilicus. The two cases had laparoscopic resection of urachus cysts. Discussion: Laparoscopy represents a good alternative for the management of persistent or infected urachus, especially when this is suspected, despite a lack of radiological evidence. Laparoscopy in the management of urachal cysts is safe, effective, and offers good cosmesis, with all the advantages of a minimally invasive approach. Conclusion: Managing persistent and symptomatic urachal anomalies requires a wide surgical excision. Such intervention is recommended to prevent symptom recurrence and complications, most notably malignant degeneration. A laparoscopic approach offers excellent outcomes, and is recommended to treat these abnormalities. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

It is defective obliteration of the urachus that causes urachal cysts. Failure of urachus to involute can contribute to anomalies that may increase the risk of infection and/or malignancy if left untreated. A 29-year-old female with clinical features suggestive of acute abdominal pain is presented in this case report. Complete blood counts, serum electrolytes, urinalysis, renal function tests were normal. In the suprapubic region, an ultrasonographic examination revealed a hypoechoic lesion measuring 2 cm × 1.5 cm in size and contrast-enhanced CT scan confirmed a non-communicating urachal cyst between abdominal wall and urinary bladder's anterior wall. Urine culture revealed significant growth of Escherichia coli and was susceptible to eight out of fifteen antibiotics. The patient was successfully treated with parenteral amikacin. In clinical office, urachal cysts need to be diagnosed and managed promptly with a high degree of suspicion. Radiology, urine culture & sensitivity are effective strategies to curb the acute presentation of Urachal Cyst. [ABSTRACT FROM AUTHOR]

Teaching Point: Infected urachal cysts are a rare cause of abdominal complaints and can be accurately diagnosed by abdominal ultrasound and computed tomography (CT).

Patent urachus is a type of urachal anomaly in which the urachus does not tail off but remains connected to the bladder in the umbilicus. The prevalence of patent urachus is very low. Herein, we report a case of patent urachus ruptured and exposed to amniotic fluid in utero. In this case, the size decreased after the second trimester, which was thought to be due to rupture in utero. After delivery, patent urachus was confirmed by inserting a foley catheter, which runs through a ruptured cyst on umbilical cord insertion. The day after delivery, the neonate underwent surgical excision of the urachal cyst and closing umbilicus. The mechanism of patent urachus rupture is unknown. As the fetus matures, it is thought that the higher intravesical pressure may affect the rupture of the cyst. Patent urachus could be ruptured in the uterus spontaneously, and surgical correction is needed. Therefore, prenatal differential diagnosis is important. [ABSTRACT FROM AUTHOR]

Urachal cysts are conditions present at birth that usually occur in children. This disease is very rare in adults. Approximately 35% of patients present with complaints of lower abdominal pain, signs of urinary tract infection, painful lumps in the abdomen, and hematuria. Here we present a case of A 27 year old woman came to the emergency unit with a lump in her stomach since 3 months before admitted to the hospital, located in the lower abdomen, the initial lump was the size of a marble, it got bigger over time and the patient felt feverish. The lump size was the size of a fist and burst open releasing pus and blood. This patient was diagnosed using CT-scan and Ultrasonography. This patient did not undergo any treatment, and chose to go home resulting in a loss to follow up. Urachal residual disease is a rare and manifests with nonspecific abdominal or urinary tract signs and symptoms. Although rare, disorders of the urachus can take the form of acute, life-threatening infections or malignant degeneration. It is important to carry out an accurate diagnosis and appropriate treatment. Urachal anomalies are rare in adults and often undiagnosed due to their nonspecific clinical course. Early diagnosis using several modalities such as ultrasonography and CT-Scan can help in planning an appropriate surgical intervention, thereby reducing morbidity., (© 2024 The Authors.)

Omphalitis is an infection of the umbilicus that can cause inflammation to spread. Omphalitis is rare in adults; however, it can occasionally occur owing to urachal remnants. A 61-year-old male patient with abdominal pain and umbilical pus was admitted to the emergency room. Abdominal computed tomography revealed peritonitis with multiple intra-abdominal abscesses. The patient was diagnosed with peritonitis resulting from urachal cyst rupture. Laparoscopic drainage of the abscesses and excising of the umbilicus and intra-abdominal fistula tract were performed. Antibiotics were administered, and the patient was discharged uneventfully. The rarity of peritonitis caused by infection and urachal cyst rupture can make diagnosing omphalitis challenging. Therefore, in this case report and literature review, we discuss the diagnosis and treatment of complicated omphalitis, which rarely progresses to peritonitis owing to ruptured urachal cysts.

Abstract Objective To investigate the feasibility and efficacy of carrying out pediatric laparoscopic partial cystectomies (LPC) when treating benign bladder tumors and urachal cysts. Methods Retrospectivey analyzing 4 clinical cases involving children with bladder tumors, which were collected from October 2017 to December 2018. In these clinical cases, there were 3 male children and 1 female child, aged from 4.5 to 9.4 years old, with an average age of 6.5 years. An intraperitoneal laparoscopic partial cystectomy was performed in the treatment of 3 of these patients with benign bladder tumors and in 1 patient with an urachal cyst. The surgical procedures included a partial cystectomy and a complete intracavitary bladder suture. Results All 4 cases were successful and no operation was transferred to opensurgery. The operation time was 100–120 min, with an average time of 108 min. The intraoperative blood loss was 10–20 ml, with an average loss of 15 ml. 6 h after the operation, the patients still maintained a fluid diet and 1 case of hematuria had occurred, with the catheter removed 12 days after the operation. No postoperative urine leakage, intestinal adhesion or intestinal obstruction occurred, and the average postoperative hospitalization time was 14 days. Conclusion Laparoscopic partial cystectomy is a safe and feasible method to be used for the treatment of benign bladder tumors and urachal cysts. It presents the advantages of being minimally invasive, and having a quick recovery and short hospitalization time. It is an alternative surgical method for the treatment of pediatric benign bladder tumors.

The urachal remnants and Meckel's diverticulum derived from the yolk sac at the eight-day of life. Even if they have a common embryological origin, the association between their abnormalities is exceptional. We report the case of a two-year-old girl who underwent surgery for acute abscesses of a urachal cyst. The surgical exploration found an association with a Meckel's diverticulum. Good outcome after surgery.

Abstract 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.

Abstract Background The 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 presentation A 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. Conclusions It 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.

We report the case of a 16-year-old girl who complained of stomach discomfort. She's been on medical therapy for roughly 6 months after being diagnosed with Crohn's disease. Magnetic resonance enterography confirmed the diagnosis of an infected urachal cyst, and she eventually had surgery. The removed material had a significant chronic inflammatory and foreign body type granulomatous response, according to histology. Because urachal cyst is an uncommon disease, early identification requires a high level of suspicion, and urachal cyst should be included in the differential diagnosis.

Teaching Point: Infected urachal cysts are a rare cause of abdominal complaints and can be accurately diagnosed by abdominal ultrasound and computed tomography (CT). [ABSTRACT FROM AUTHOR]

Abstract Background A retained surgical sponge, also known as a gossypiboma, is a rare cause of serious postoperative complications. Diverse retained surgical materials including instruments such as clamps and sutures have been reported, but surgical sponges are the most common material. We report an unusual case of a gossypiboma mimicking a complicated urachal cyst that led to perforation of the umbilicus. Case presentation A 38-year-old female patient presented in our facility with a palpable periumbilical mass and discharge of pus from the umbilicus for 7 months after an open appendectomy. Since the onset of symptoms, the patient had been treated conservatively in a peripheral hospital where she had been operated on. As no improvement was seen, an ultrasound scan was performed that suggested an intraperitoneal abscess adjacent to the umbilicus. Consequently, the patient was referred to our specialist outpatient department for surgical intervention. Suspecting a complicated urachal cyst, an exploratory laparotomy was performed but revealed a retained surgical sponge as the underlying cause. The gossypiboma was resected, and the postoperative period was unremarkable. Conclusion This case demonstrates that gossypibomas, even though rare, continue to occur. They may clinically and radiologically mimic other pathologies, especially abscesses and tumors. Preventive measures as well as the inclusion of gossypibomas in the differential diagnosis of intraabdominal masses or fistulation detected in patients with a history of surgery are of utmost importance to minimize morbidity, mortality, and potential medicolegal implications.

Bladder urachal cysts in children are a rare form of urachal abnormality. In this paper, we present a case of atypical imaging that presented with lower abdominal pain accompanied by hematuria, resulting in the formation of both internal and external urachal cysts in a child. A 6-year-old male child presented with repeated abdominal pain over a span of 4 days. Color ultrasound and pelvic CT scans revealed a soft tissue lesion on the right anterior wall of the bladder with an unclear boundary from the bladder wall. Voiding Cystourethrography (VCUG) showed no significant abnormalities in the bladder, while routine urine testing was positive for hematuria. A cystoscopy was simultaneously performed with a laparoscopic resection of the urachal cyst. Intraoperative cystoscopy identified the intravesical lesion, which was precisely removed using a cystoscope-assisted laparoscopy. Postoperative pathology confirmed that both extravesical and intravesical lesions were consistent with a urachal cyst. No complications were observed after the operation, and no recurrence was noted during a six-month follow-up. Therefore, for urachal cysts at the bladder's end, the possibility of intravesical urachal cysts should not be excluded, especially in patients with microscopic hematuria. We recommend performing cystoscopy simultaneously with laparoscopic urachal cyst removal to avoid missing intravesical lesions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Mao, Wang, Mao, Shang, Zhou and Zhao.)

Objective: To investigate the feasibility and efficacy of carrying out pediatric laparoscopic partial cystectomies (LPC) when treating benign bladder tumors and urachal cysts.Methods: Retrospectivey analyzing 4 clinical cases involving children with bladder tumors, which were collected from October 2017 to December 2018. In these clinical cases, there were 3 male children and 1 female child, aged from 4.5 to 9.4 years old, with an average age of 6.5 years. An intraperitoneal laparoscopic partial cystectomy was performed in the treatment of 3 of these patients with benign bladder tumors and in 1 patient with an urachal cyst. The surgical procedures included a partial cystectomy and a complete intracavitary bladder suture.Results: All 4 cases were successful and no operation was transferred to opensurgery. The operation time was 100-120 min, with an average time of 108 min. The intraoperative blood loss was 10-20 ml, with an average loss of 15 ml. 6 h after the operation, the patients still maintained a fluid diet and 1 case of hematuria had occurred, with the catheter removed 12 days after the operation. No postoperative urine leakage, intestinal adhesion or intestinal obstruction occurred, and the average postoperative hospitalization time was 14 days.Conclusion: Laparoscopic partial cystectomy is a safe and feasible method to be used for the treatment of benign bladder tumors and urachal cysts. It presents the advantages of being minimally invasive, and having a quick recovery and short hospitalization time. It is an alternative surgical method for the treatment of pediatric benign bladder tumors. [ABSTRACT FROM AUTHOR]

Patent urachus is a type of urachal anomaly in which the urachus does not tail off but remains connected to the bladder in the umbilicus. The prevalence of patent urachus is very low. Herein, we report a case of patent urachus ruptured and exposed to amniotic fluid in utero. In this case, the size decreased after the second trimester, which was thought to be due to rupture in utero. After delivery, patent urachus was confirmed by inserting a foley catheter, which runs through a ruptured cyst on umbilical cord insertion. The day after delivery, the neonate underwent surgical excision of the urachal cyst and closing umbilicus. The mechanism of patent urachus rupture is unknown. As the fetus matures, it is thought that the higher intravesical pressure may affect the rupture of the cyst. Patent urachus could be ruptured in the uterus spontaneously, and surgical correction is needed. Therefore, prenatal differential diagnosis is important.

Background: Urachal cysts are an uncommon congenital abnormality that result from the incomplete obliteration of the urachus [1]. Typical presentation is in childhood, and previous pediatric autopsy studies have shown an incidence to be 1 in 5000 cases [2]. These urachal cysts are frequently asymptomatic, however, some patients can present with symptoms of lower abdominal pain, features of urinary tract infection, a painful abdominal lump, and/ or hematuria [3]. Differential diagnosis for an uninfected urachal cyst includes a bladder diverticulum, vitelline cyst, mesenteric cyst, Meckel diverticulum, and an umbilical hernia. Bladder adenocarcinoma should be considered as a differential diagnosis for an infected urachal cyst. Objective: To share the surgical case of a robot-assisted excision of a calcified urachal cyst. Methods/materials: We present the case of a 50-year-old previously healthy female who presented with intermittent gross hematuria for 1 year. CT Urogram demonstrated a urachal sinus cystic and calcified mass. Cystoscopy performed in clinic showed no obvious connection from the bladder to the urachus. The decision was made to proceed with a robot-assisted excision of the calcified urachal cyst. Results: Intra-operatively, there was an obvious urachal cyst identified several centimeters superior to the decompressed bladder. The cyst was excised with a circumferential margin, and the resulting bladder defect was closed in two layers using 3–0 V-lock. The bladder was filled to demonstrate there was no leak. The urachal cyst was removed without complication. Conclusion: Urachal cysts are a rare anomaly with a heterogenous clinical presentation. Robot-assisted surgery provides a minimally invasive technique for excision of a urachal cyst when indicated.

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. [ABSTRACT FROM AUTHOR]

Background: The 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 presentation: A 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. Conclusions: It 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. [ABSTRACT FROM AUTHOR]

L'ouraque est un résidu fibreux de l'allantoïde qui disparaisse après la naissance. Dans certains cas, il peut persister, on parle alors d'anomalies de l'ouraque. Cette persistance de l'ouraque est manifestée par des douleurs abdominales et peut être signalée par des complications, dont l'infection est la complication la plus courante. L'infection peut être mal comprise et confondue avec d'autres pathologies, surtout lorsqu'elle est associée à une douleur abdominale. Nous rapportons dans notre cas une observation de kyste de l'ouraque infecté, révélé par une douleur abdominale fébrile. The urachus is a fibrous residue of the allantois which disappears after birth. In some cases, it can persist, we then speak of anomalies of anomalies Urachal. This persistence of the uracah is manifested by abdominal pain and can be signaled by complications, of which infection is the most common complication. The infection can be misunderstood and confused with other pathologies, especially when it is associated with abdominal pain. In our case, we report an observation of an infected Urachal cyst, revealed by febrile abdominal pain. [ABSTRACT FROM AUTHOR]

• Urachal cyst is a common anomaly related to the incomplete obliteration of the urachal lumen. • This condition, per se asymptomatic, is not without risk. • In symptomatic cases, the main approach is the laparoscopic excision. Incomplete obliteration of the urachal lumen could cause different types of anomalies and urachal cyst is the most common among these in the adult population. It is usually asymptomatic and may be an incidental finding during a surgical exploration for other reasons. However, it can be subject to complications. A 38-year-old female patient with history of worsening lower-quadrants abdominal pain, associated with fever and chills, presented to emergency room; clinical examination revealed a painful, tender, and fixed lump to the left inferior abdominal quadrant. Ultrasound reveled a left adnexal mass and, along the midline, between the adnexal mass, the bladder and the uterus, was evident a 3-cm unilocular cyst with regular walls and hypoechoic content. MRI confirmed the suspicion of a left tubo-ovarian abscess and suggested a diagnosis of urachal remnant for the smaller midline cyst. In this report, we describe the step-by-step laparoscopic management of the case, paying attention to "the tips and tricks" for urachal cyst excision. The urachal cyst, which results from the accumulations of secretions in urachal remnant, presents as a single or multiple parietal abdominal mass, per se asymptomatic. However, this condition is not without risk and infection represents the most common complication. Ultrasound is very useful in the diagnostic phase. Today, the main approach has become laparoscopic excision, with particular attention to a radical removing of the mass, due to high recurrence rate and the risk of malignancy. In our experience, laparoscopy represents an excellent diagnostic and therapeutic tool for urachal cyst, especially for patients with acute urgent conditions, doubtful clinical history, and no clear signs or symptoms. [ABSTRACT FROM AUTHOR]

Urachal anomalies, and urachal cysts in particular, are common congenital anomalies that can remain asymptomatic throughout a lifetime or rarely cause life threatening illness if infected. We present a case of a complicated infected urachal cyst and review the literature on its work up and management, including the controversial issue of whether surgical management is always necessary for definitive treatment of this entity.

An urachal cyst is a sinus remaining from the allantois during embryogenesis which is rarely manifested in adults. The urachus is an embryologic remnant which degenerates after the birth. Defective obliteration of the urachus leads to urachal abnormalities. Urachal cyst is a rare pathology in adult women, and this pathology should be considered in the differential diagnosis of acute abdomen. Xanthogranulomatous cystitis (XC) is a benign disease of unknown etiology. The clinical manifestations of these are nonspecific such as lower abdominal pain, umbilical discharge with occasional hematuria. Urachal lesions present with persistent umbilical drainage in infants and newborn. However, in 35% cases, enclosed urachal cyst or infected urachal cyst (abscess) manifests without having umbilical discharge. Computed tomography scan and magnetic resonance imaging are of little help to the identification of these preoperatively. Here, we present a rare case of urachal cyst with XC in 30-year-old female which has produced diagnostic dilemma.

Introduction: Meckel’s diverticulum (MD), a remnant of the omphaloenteric duct, is among the most frequent intestinal malformations. Another embryonic vestige is the urachus, which obliterates, becoming the median umbilical ligament; the failure of this process can lead to a urachal cyst formation. We present a case of Meckel diverticulitis misdiagnosed as an infected urachal cyst. Presentation of case: A 16-year-old girl presented with hypogastric pain, fever and vomiting. She had undergone an appendectomy 6 years prior and no digestive malformation had been documented. In the last 2 years, she had 3 events of urinary tract infections with Escherichia coli, and anabdominal ultrasound discovered a 28/21 mm hypoechogenic preperitoneal round tumor, anterosuperior to the bladder. We established the diagnosis of an infected urachal cyst, confirmed later by magnetic resonance imaging. Intraoperative, we found MD with necrotic diverticulitis attached to the bladder dome. Discussions: Meckel’s diverticulum and urachal cyst (UC) are embryonic remnants. Both conditions are usually asymptomatic, being incidentally discovered during imaging or surgery performed for other abdominal pathology. Imaging diagnosis is accurate for UC, but for MD they are low sensitivity and specificity. For UC treatment, there is a tendency to follow an algorithm related to age and symptoms, but there is no general consensus on whether to perform a routine resection of incidentally discovered MD. Conclusion: Preoperatory diagnosis of MD represents a challenge. We want to emphasize the necessity of a thorough inspection of the small bowel during all abdominal surgical interventions and MD surgical excision regardless of its macroscopic appearance. These two actions seem to be the best prophylaxis measures for MD complications and consequently to avoid emergency surgery, in which case more extensive surgical procedures on an unstable patient may be needed.

Background: The traditional surgical approach to the excision of persistent urachal remnants is a lower midline laparotomy or semicircular infraumbilical incision. The aim of this study is to report our experience with laparoscopic urachus excision as a minimally invasive diagnostic and surgical technique. Methods: This study was a prospective study involving patients who were diagnosed with persistent urachus and underwent laparoscopic excision. The morbidity, recovery, and outcomes of surgery were reviewed. Results: Fourteen patients (8 men) with a mean age of 22.8 ± 6.42 years underwent laparoscopic excision. All patients presented with discharge from the umbilicus. Although four patients had no sonographic evidence of a patent urachus, a diagnostic laparoscopy detected a patent urachus that was excised laparoscopically. One patient required laparoscopic reoperation for persistent discharge, and one patient presented with bladder injury, which was repaired via a small Pfannenstiel incision without any morbidity. The mean operative time was 71.1 ± 0.28 minutes, and the mean duration of hospital stay was 1.3 ± 1.38 days. Pathological examination confirmed a benign urachal remnant in all cases. Conclusion: Laparoscopy is a useful alternative for the management of persistent or infected urachus, especially when its presence is clinically suspected despite the lack of sonographic evidence. The procedure is associated with low morbidity, although a small risk of bladder injury exists, particularly in cases of severe active inflammation. Recurrence is uncommon and was caused by inadequate excision of inflammatory tissue in our series that was easily managed laparoscopically.