Urachus Fistula: A Rare First Presentation of Appendicitis
Yu‐Hsiang Yang a Yi-Kai Chang
aDepartment of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Urachus anomalies are remnants of the urachus, an embryonic connection between the fetal bladder and umbilicus. These anomalies usually remain asymptomatic but can cause symptoms in case of infection. An extremely rare complication of symptomatic urachal remnants is fistulizing to adjacent viscera. We describe the first case of diverticulitis associated appendix-urachal-vesical fistula.
An 36 year-old female visited the emergency room with para-umbilical abdominal pain and nausea sensation for hours. Examination showed a normal looking umbilicus with gassy discharge from her umbilicus. Laparotomy and CT revealed a fistula extending from the umbilicus to a pus filled cyst superior to the bladder(Fig 1,2). A second fistula between the cyst and appendix was identified. The involved appendix and bladder was resected. Pathological examination demonstrated no malignancy.
Urachal remnants are extremely rare in adults. They typically present with abdominal pain or palpable masses. Additional imaging can aid the diagnostic process.
Due to the risk of recurrence and malignant transformation, complete surgical excision of urachal anomalies is the treatment of choice. This can be done in a 1-step or 2-step procedure.