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Updated: Apr 26, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
[Giant abscessed urachal cyst in adult. Case report]
Luis Virgilio Ponce-Pérez1, Luis Eduardo Cárdenas-Lailson2, Guillermo Domínguez-Muñoz2
1Servicio de Cirugía General. Hospital Ángeles Metropolitano, México DF, Mexico. kamelv@hotmail.com.
Insights
Infected urachal cysts are rare but can mimic appendicitis. Complete surgical excision is the recommended treatment to prevent recurrence and potential malignant transformation.
Area of Science:
- Urology
- Surgical Pathology
Background:
- The urachus connects the bladder dome to the allantoic duct during gestation.
- Urachal cysts are rare in adults, affecting approximately 2% of the population.
- Infections often occur in young adults, with potential hematogenous, lymphatic, or direct origins.
Observation:
- A 30-year-old male presented with abdominal pain and a large abdominal mass.
- CT imaging suggested a bladder-dependent cystic tumor.
- Exploratory laparotomy revealed an infected urachal cyst with 3,000 cc of purulent material.
Findings:
- The patient underwent partial anterior resection of the urachal cyst due to adherence to bowel loops.
- The patient showed satisfactory recovery post-surgery.
- Urachal abnormalities have a 2:1 male-to-female ratio.
Implications:
- Infected urachal cysts require complete excision, not just incision and drainage, due to malignant transformation risk.
- Urachal cyst is a rare differential diagnosis for acute appendicitis.
- Complete excision ensures definitive treatment for urachal cysts.
Background:
during gestation, the urachus represents the connection between the dome of the bladder and the allantoic duct. This infection occurs preferentially in young adults, advocating the haematogenous or lymphatic pathway as possible routes of transmission, while a cord or bladder origin may also occur. Urachal cysts are rare in adult life, and is observed in only about 2% of adults.
Clinic Case:
A 30-year-old male patient with a history of alcoholic hepatitis, diabetes mellitus type 2, chronic malnutrition, increased volume beginning with generalized abdominal pain, abdominal tumor of 20 by 15 cm, mobile, solid, without signs of peritoneal irritation. CT showed the presence of tumor, probably bladder-dependent, and apparently cystic. Exploratory laparotomy was found infected urachal cyst, draining 3,000 cc purulent material. A partial resection of the anterior face, keeping the back by firm adherence to bowel loops was done and is evolving satisfactorily.
Discussion:
urachal abnormalities are rare, with male / female ratio of 2 / 1. Although urachal abscess is an infection confined to an enclosed space, definitive treatment should not be the simple incision and drainage, because of the possibility of malignant transformation of urachal remnants. The definitive treatment should be considered complete excision of urachal cyst, when the infection is limited.
Conclusion:
the urachus cyst is a rare pathology and is a diferencial diagnosis for acute appendicitis and it is necessary to know this treatment.
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