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Peritonitis due to intraperitoneal perforation of infected urachal cysts
Insights
Perforation of infected urachal cysts can cause life-threatening bacterial peritonitis, especially in young males. Early diagnosis via imaging and surgical excision of the urachal remnant offer a curative solution.
Area of Science:
- Urology
- Pediatric Surgery
- Infectious Diseases
Background:
- Urachal anomalies are rare fetal developmental issues.
- Infected urachal cysts can perforate, leading to severe intra-abdominal infection.
- Acute bacterial peritonitis from a perforated urachal cyst is a rare but serious complication.
Observation:
- This study reports four cases of perforated infected urachal cysts, including the first preoperatively diagnosed case.
- The condition predominantly affects young males presenting with acute peritonitis, often without clear signs of urachal anomaly.
- Bacteriological analysis revealed diverse infecting organisms.
Findings:
- Emergency laparotomy and complete excision of the urachal remnant were performed in all cases.
- Review of these cases and seven prior reports confirms the disease's predilection for young males.
- Preoperative diagnosis can be achieved using umbilical sinography or abdominal ultrasonography.
Implications:
- Accurate preoperative diagnosis of urachal cyst perforation is possible with specific imaging techniques.
- Prompt treatment with broad-spectrum antibiotics and surgical excision of the urachal remnant leads to a curative outcome.
- Understanding this rare condition is crucial for timely and effective management in pediatric and general surgery.
Abstract:
Acute bacterial peritonitis due to intraperitoneal perforation of an infected urachal cyst represents a potentially lethal complication of the rare anomalies of the fetal urachus. We report four cases of this disease, including what we believe is the first to have been correctly diagnosed prior to operation. All four patients underwent emergency laparotomy and curative excision of the urachal remnant. Review of our four cases plus seven previously reported cases disclosed the perforated urachal cyst to be predominantly a disease of young males who initially have acute peritonitis but often without specific indication of a urachal anomaly. Bacteriologic examination has identified a wide variety of infecting organisms. Umbilical sinography or abdominal ultrasonography may allow accurate preoperative diagnosis. Broad-spectrum antibiotic coverage and laparotomy are indicated and excision of the entire urachal remnant is consistently curative.