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)
This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1007%2Fs11606-016-3804-1.pdf
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