An Abscess of Urachal Remnant

Journal of General Internal Medicine, Jul 2016

Yuta Hirose MD, Kiyoshi Shikino MD, PhD, Masatomi Ikusaka MD, PhD

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An Abscess of Urachal Remnant

Yuta Hirose 0 Kiyoshi Shikino 0 Masatomi Ikusaka 0 Compliance with Ethical Standards: 0 Department of General Medicine, Chiba University Hospital , Chiba-city, Chiba , Japan - A 43-year-old man presented with one week of abdominal pain and umbilical discharge (Fig. 1). On exam, there was a painful mass in the infraumbilical region and a positive Carnett’s sign (increased pain with tensing of the abdominal muscles suggestive of abdominal wall pathology). Urine test results were negative. Abdominal enhanced computed tomography showed a rim-enhancing mass and a linear lesion between the mass and bladder dome (Fig. 2). Culture of the umbilical discharge was positive for Peptoniphilus species. Urachal remnant abscess was diagnosed. After abscess drainage and intravenous antibiotics administration, the symptoms alleviated. The urachus, a vestigial structure connecting the bladder dome to umbilicus, occludes and normally becomes a fibrous cord after birth.1 If occlusion is insufficient, an urachal remnant forms and may eventually become infected. Tenderness between the umbilicus and lower abdomen in conjunction with pus discharge from the umbilicus are indicative of a urachal remnant abscess.2 Urine test results are negative in more than 80% of cases.1 The differential diagnoses include BUmbilicus cellulitis^ and a BSister Mary Joseph’s nodule.3 ^ After resolution of the infection, there are recommendations that the urachal remnant should be excised to prevent recurrent infection and avoid the risk of neoplastic transformation.1 Acknowledgements: We are grateful to Dr. Akinori Takei, Department of Urology, Chiba University Hospital, for managing the patient. Conflict of Interest: The authors declare that they do not have a conflict of interest. 1. Tazi F. Abscess of urachal remnants presenting with acute abdmen: a case series . J Med Case Rep . 2012 ; 6 : 226 - 232 . 2. EI Ammari JE . Urachal sinus presenting with abscess formation . ISRN Urol . 2011 ; 2011 : 820924 . 3. Miller T , Ashworth J , Richards S. Sister Mary Joseph nodule . BMJ . 2015 ; 351 : h5224 . (...truncated)


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Yuta Hirose MD, Kiyoshi Shikino MD, PhD, Masatomi Ikusaka MD, PhD. An Abscess of Urachal Remnant, Journal of General Internal Medicine, 2017, pp. 360, Volume 32, Issue 3, DOI: 10.1007/s11606-016-3804-1