Case report - Combined Cysto-laparoscopic management of Infectious Urachal cyst with patent urachal duct
Mon-Der, Cho; Ray Hsiao
Kaohsiung Municipal Min-sheng Hospital Division of Urology1 Division of General Surgery, Department of Surgery2
27 years old male visited our clinic with a infra-umbilicus drainage tube complaint about persistent low abdominal pain. He had visited other hospital pediatric surgeon department 2 months before, with initial presentation of sudden onset infra-umbilicus cystic lesion with tenderness and local inflammatory change, he had received bed-side incision and drainage, and placement of one Jackson-Pratt drain, however due to persistent discharge about 50c.c. daily from drainage tube and symptom sign getting worse, he was then visited our clinic. At our OPD, Bedside sonography revealed a 2 cm mass like hyperechoic lesion, urine analysis revealed turbid urine without pyuria or bacteuria, wound pus culture showed Oxacillin-resistant Staphylococcus aureus. Abdominal CT showed suspect urachus cyst with obstructed urachal duct. We perform combined cysto-laparoscopic excision of urachal duct, distal opening was excised and sealed via thulium laser, infra-umbilical proximal opening was clipped and excised. Umbilical wound was wide open for wet dressing, the whole procedure was smoothly performed, and umbilical wound was closed 5 days later. Surgical image and literature will be further discussed.