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Updated: Sep 26, 2025

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Vesicourachal diverticulum.

G Mohamed1, Z Ghani1, N Lynn1

  • 1Shrewsbury and Telford Hospital NHS Trust, UK.

Annals of the Royal College of Surgeons of England
|April 21, 2022
PubMed
Summary
This summary is machine-generated.

A rare complication occurred during laparoscopic appendicectomy when a pelvic drain injured the bladder via a vesicourachal diverticula. This highlights the need for careful port insertion and imaging in laparoscopic surgery.

Keywords:
Bladder injuryCystogramLaparoscopic appendectomyUrachusVesicourachal diverticulum

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Surgical Complications

Background:

  • Laparoscopic appendicectomy is a common procedure for appendicitis.
  • Vesicourachal diverticula are rare congenital anomalies of the urachus.
  • Pre-operative bladder catheterization is standard to minimize bladder injury risk.

Observation:

  • A healthy 45-year-old male developed abdominal pain and high drain output post-appendicectomy.
  • Initial computed tomography (CT) cystogram showed no bladder injury.
  • Elevated drain fluid creatinine and conventional cystogram confirmed urine leak.

Findings:

  • Flexible cystoscopy revealed the pelvic drain had traversed a vesicourachal diverticula.
  • The drain was repositioned as a suprapubic catheter, leading to patient discharge.
  • The CT cystogram's unreliability due to poor bladder distension contributed to the missed diagnosis.

Implications:

  • This case underscores the importance of meticulous port placement during laparoscopic procedures.
  • Enhanced vigilance is required for rare anomalies like vesicourachal diverticula.
  • Consider traditional cystography when CT cystography is negative but bladder injury is suspected.