臍尿囊囊腫感染併膿瘍以下泌尿道症狀來表現

李建昌¹ 劉緯陽¹ 張志鵬¹ 郭振華¹

¹大里仁愛醫院 外科部 泌尿科

Urachal cyst with abscess formation appeared  with low urinary tract symptoms

 Chien-Chang Li¹, Wayne-Young Liu¹, Chih-Peng Chang¹, Jehn- Hwa Kuo¹

¹Division of Urology, Department of Surgery, Jen-Ai Hospital, Taichung, Taiwan

Purpose:

The urachal remnant occurs in approximately 1 in 5000 patients and there are four common types. Most of the urachal remnant was asymptomatic and it was noted through image study incidentally. The most complication  associated with  urachal remnant is infection. We present that one case has  urachal remnant initially but he went to clinic OPD for severe low urinary tract symptoms about 2 years. It was impressed as overactive bladder and he received medical treatment for a period of time. The further invasive management was done because he had high fever and the urachal remnant became urachal abscess. We want  to present clinical course of this case for differential diagnosis and share the experience of treatment.

Key Words : urachal remnant, urachal cyst, abscess   

Materials and Methods:

A  33 years old male suffered from the frequency for 2 years and the symptom progressed in these month. He ever went GU OPD for it and ever received urodynamic survey and cystoscopic exam. However no specific lesion was noted and it was suspected as painful bladder symptom. However he was admitted for high fever and mild abdominal pain later. Initially the fever source was not detected since the exam associated with respiratory, gastrointestinal and urinary tract was normal. Following it the inflammation scan  revealed the hypogastric lesion above the urinary bladder. Therefore the abdominal CT was arranged and the urachal abscess was noted. Because the pt had septic condition, therefore the percutaneous drainage was arranged  at first. The further surgical debridement was done later. After operation the patient recovered well and the LUTS was also resolved.

Results and Discussion

The urachal urachal remnant is not rare and  there are five types of urachal abnormalities: 1. patent urachus (50%) ; 2. urachal cyst (30%); 3. urachal sinus (15%); 4. vesicourachal diverticulum (3–5%); and 5. alternating sinus. Urachal sinus abscess usually occurs by infection of mucinous secretion via the umbilicus. The commonly cultured microorganisms from the pus are Escherichia coli, Enterococcus faecium, Proteus, Streptococcus viridans and Fusobacterium. The clinical signs and symptoms are nonspecific, as urachal sinus is largely asymptomatic until they become infected. Utrasonography could help in establishing the diagnosis in 77% of patients, but the computed tomography (CT) scan is more adequate for urachal remnant. Urachal cyst treatment depends on the presence of complications or associated conditions. Non-infected urachal sinus are usually removed in a single-step radical excision of the remnant via open or laparoscopic surgical approach. In case of infection, a single-stage procedure backed with appropriate antibiotic therapy or 2-stage procedure involving initial incision and drainage, followed by later excision of the urachal remnant are adopted with more smooth course. In our case we did the 2 2-stage procedure treatment. The pt was discharged in well condition.