Fish bone migration into urachus mimicking urachal malignancy: A rare case report

Foreign bodies can find their way into and around the bladder usually via urethra by self insertion, migration from surrounding structures and by penetrating trauma. The clinical presentation being varied, symptoms nonspecific and history often concealed makes diagnosis quite difficult. Fish bone ingestion has been reported to caused bowl perforation and rarely migrate to other surrounding structures. We present a case of 39 year old male who presented to us with LUTS and lower abdominal mass. Evaluation revealed a mass extending from the dome of urinary bladder to umbilicus. Imaging modalities could not certainly characterize the nature of this lesion. Contrast CT revealed a large, irregular, enhancing mass with thin streak of central calcification and necrosis raising the possibility of urachal malignancy. The mass was excised enblock along with dome of urinary bladder and revealed a long fish bone in the center of specimen. Foreign bodies in the urachus are very rare and may present as inflammatory masses which are difficult to differentiate from the malignant pathology. Imaging when augmented with proper history and clinical examination plays a crucial role in the identification of these foreign bodies and helps to differentiate these inflamatory masses from more sinister malignant pathologies.