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An infected urachal cyst presenting as acute abdominal pain in a child: A case report
I-Shan Tsai1, Lung-Huang Lin2, Shih-Pin Hung2
1Department of Pediatrics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City.
Insights
An infected urachal cyst, a rare pediatric condition, can mimic appendicitis. Surgical excision and antibiotics are effective treatments, with abdominal echo scans aiding diagnosis and preventing complications.
Area of Science:
- Pediatric Surgery
- Urology
- Diagnostic Imaging
Background:
- Urachal cysts are rare congenital anomalies resulting from incomplete urachal remnant obliteration.
- Infection is the most common complication, presenting with nonspecific abdominal pain that can mimic acute appendicitis.
- Delayed diagnosis of infected urachal cysts can lead to life-threatening complications.
Observation:
- A 5-year-old boy presented with severe, intermittent lower abdominal pain.
- The patient was diagnosed with an infected urachal cyst.
- Initial symptoms were nonspecific, raising concern for other acute abdominal conditions.
Findings:
- Surgical resection of the urachus combined with intravenous antibiotics led to successful treatment.
- The patient recovered fully within 6 months post-surgery with no sequelae.
- Abdominal echo scans offer high sensitivity and a non-radioactive method for differentiating urachal cysts.
Implications:
- Prompt diagnosis and surgical management of infected urachal cysts are crucial in pediatric patients.
- Abdominal ultrasound and CT scans are valuable tools for diagnosing urachal cysts.
- While surgical excision is effective, long-term monitoring for potential malignant transformation is advisable.
Introduction:
Urachal cyst is an exceptionally rare disease in children caused by the incomplete obliteration of the urachal remnant. Urachal cysts seldom cause symptoms unless a secondary infection occurs. The symptoms of an infected urachal cyst are nonspecific and may be similar to acute appendicitis or other acute abdominal conditions. However, complications attributable to a delayed diagnosis can endanger the life of a patient.
Patient Concerns:
A 5-year-old boy presented with a 3-day history of severe intermittent lower abdominal pain.
Diagnosis:
Infected urachal cyst.
Interventions:
The patient was treated with surgical resection of the urachus, followed by intravenous antibiotics during the hospitalization.
Outcomes:
The patient was discharged without incident 7 days after the operation. With his follow-up in our out-patient department, he recovered well without any sequelae in the 6 months post-surgery.
Conclusion:
We suggested using the abdominal echo scan to differentiate the urachal cyst because of its high sensitivity and nonradioactive characteristic, and computed tomography is a typical diagnostic tool for urachal cysts. The mainstream management of an infected urachal cyst remains surgical excision. Complete excision of urachal cysts is relatively easy in a pediatric patient and the risk of subsequent infection is low; however, patients tend to have a low, although possible, risk of potential malignant transformation over their lifetimes.
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