INFECTED URACHAL SINUS PRESENTING AS ABDOMINAL WALL ABSCESS: TWO CASE REPORTS WITH REVIEW OF THE LITERATURE

Objectives: Urachal remnants are rare anatomical defects and can easily be missed by clinicians, thus a high degree of suspicion is required for diagnosis.

Methods: We report three cases of urachal sinus with their management and compare presentation and outcomes with current literature.

Results: The ages of the three patients were 12, 26, and 38 respectively, and all were males. All patients presented with umbilical abscess with leukocytosis and imaging showing abdominal fluid collection. The 12 year-old patient was initially treated with antibiotics and drainage which was followed by elective excision of the urachal sinus. Pathology showed fibromuscular soft tissue with a central opening lined by hyperplastic benign urothelial epithelium. The 26 year old patient presented with an inflamed urachal abscess, underwent drainage of the abscess and excision and pathology of the urachal sinus showed fibro-collagenous tissue with acute and chronic inflammation. The 38 year-old patient had prior drainage of abdominal wall abscess returned 4 months later with recurrence of the abscess. He underwent laparoscopic excision of urachal sinus with drainage of the abscess. Pathology showed a urachal sinus tract with infection. The post-operative recovery of all the patients was uneventful.

Conclusion: Early diagnosis and proper management of urachal remnant abnormalities is crucial in preventing recurrent infections and long-term complications that are associated with them. Proper workup of a patient presenting with infraumbilical abdominal pain and erythema and/or recurrent urinary tract infections, including the utility of an abdominal CT scan is warranted. Ruling out malignancy and calculus formation in adulthood area additional consideration. The rarity of the disorder prevents universal screening guidelines, but we believe a multi-institutional study could aid in establishing screening guidelines in children and adults presenting with recurrent voiding symptoms or infraumbilical erythema.