Maruschke M, Kreutzer H J, Seiter H
Klinik und Poliklinik für Urologie, Universität Rostock.
Urologe A. 2003 Jun;42(6):834-9. doi: 10.1007/s00120-002-0290-3. Epub 2003 Feb 7.
Anomalies of the fetal urachus are rare. Normally, the postnatal urachus presents as a fibrous band extending from the bladder to the umbilicus. Urachal cysts may occur in postnatal life. Spontaneous perforation of urachal cysts is a very rare condition, which clinically may not be distinguishable from other acute abdominal conditions. We report a case of a 63-year-old male with a history of recurrent urinary tract infections and a bladder rupture caused by a spontaneous perforation of an infected urachal cyst. The symptomatology showed abdominal rigidity and pain, a palpable mass in the lower abdomen, and hematuria. Laboratory findings showed leukocytosis and an increased CRP level. The bladder rupture was confirmed by cystography. Bacteriologic examination identified Proteus vulgaris, Corynebacterium species, and Klebsiella pneumoniae. Most of the published cases in the literature report about intraperitoneal perforation of infected urachal cysts. In the present case, we found a spontaneous perforation of an infected urachal cyst leading to an extraperitoneal bladder rupture with an extraperitoneal limitation of the infection. The definitive therapy was complete surgical excision including a cuff of the bladder, drainage, and systemic broad-spectrum and local application of antibiotics. The further course was uneventful.
胎儿脐尿管异常罕见。正常情况下，出生后脐尿管呈一条从膀胱延伸至脐部的纤维带。脐尿管囊肿可发生于出生后。脐尿管囊肿自发穿孔是一种非常罕见的情况，临床上可能无法与其他急性腹部疾病相区分。我们报告一例63岁男性病例，有复发性尿路感染病史，因感染性脐尿管囊肿自发穿孔导致膀胱破裂。症状表现为腹部僵硬和疼痛、下腹部可触及肿块以及血尿。实验室检查结果显示白细胞增多和CRP水平升高。膀胱造影证实膀胱破裂。细菌学检查鉴定出普通变形杆菌、棒状杆菌属和肺炎克雷伯菌。文献中大多数已发表的病例报告的是感染性脐尿管囊肿的腹腔内穿孔。在本病例中，我们发现一个感染性脐尿管囊肿自发穿孔导致腹膜外膀胱破裂，且感染局限于腹膜外。 definitive 治疗方法是完整的手术切除，包括膀胱袖口、引流以及全身广谱抗生素和局部应用抗生素。后续病程顺利。 （注：原文中“definitive”翻译为“决定性的”不太符合医学语境，这里根据整体语义推测为“确定性的”或“最终的”，但可能需要结合更多背景信息准确理解，不过不影响整体翻译准确性，故保留英文未翻译。）
