老年糖尿病患者復發性臍尿管膿瘍之病例報告 

謝棨圳¹、張顥瀚¹

¹高雄醫學大學附設中和紀念醫院泌尿部

Management of Recurrent Urachal Abscess in an Elderly Diabetic Patient: A Case Report

Chi-Chun Hsieh¹, Hao-Han Chang¹

¹Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Abstract:

Background: Urachal remnants are rare clinical entities in adults, resulting from the incomplete obliteration of the fetal urachus. While often asymptomatic, they can lead to complications such as infection, cyst formation, or malignancy. In elderly patients with comorbidities like Diabetes Mellitus (DM) and Chronic Kidney Disease (CKD), these infections may present as chronic, non-healing abdominal wall wounds, leading to potential misdiagnosis. This case highlights the clinical challenge of a recurrent urachal abscess that necessitated definitive surgical excision after the failure of initial conservative debridement.

Cases Presentation: A 77-year-old female with DM and CKD presented with a chronic, purulent abdominal wound for weeks. Initial imaging revealed a urachal abscess, which was treated with debridement and a fascio-cutaneous flap. However, the patient returned in months later with recurrent fever and abdominal pain. A repeat CT showed a supravesical abscess and complicated cystitis. She then underwent definitive surgical excision of the urachus along with a bladder cuff repair. Intraoperative findings noted dense adhesions to the terminal ileum. Pathological examination confirmed granulation tissue and microabscesses without malignancy.

Conclusion: This case demonstrates that superficial debridement and flap coverage may be insufficient for abdominal wall infections originating from urachal remnants. In this patient, the poorly controlled DM likely contributed to the chronicity and recurrence of the infection. The definitive treatment for infected urachal cysts remains complete surgical excision, often including a cuff of the bladder to prevent future recurrence. Clinicians should maintain a high index of suspicion for urachal anomalies when encountering persistent midline infraumbilical wounds, especially in immunocompromised or diabetic populations.