脐尿管腺癌：阑尾炎破裂手术时的偶然发现。
Urachal adenocarcinoma: incidental finding at the time of surgery for ruptured appendicitis.
作者信息
Peterson Richard M, Ollayos Curtis, Merchant Deepak
机构信息
Department of Surgery, St. Agnes Hospital, Baltimore, Maryland, USA.
出版信息
JSLS. 2006 Jul-Sep;10(3):392-5.
BACKGROUND
The urachus is a vestigial structure between the dome of the bladder and the umbilicus. Tumors may develop from the remnants, most of which are well-differentiated, mucinous adenocarcinomas. Urachal adenocarcinoma is an exceedingly rare type of tumor.
METHODS
We present a case of a 51-year-old female presenting to our institution with complaints of abdominal pain for 36 hours. The patient was taken to the operating room for an acute appendicitis. Laparoscopy was performed, and gross purulence and appendiceal perforation were noted as well as a mass on the anterior abdominal wall. Based on the location of the mass, we converted to an open midline laparotomy to treat both the perforated appendicitis and to remove the mass.
RESULTS
Pathology confirmed the diagnosis of perforated appendicitis and a mucinous-producing urachal adenocarcinoma.
DISCUSSION
Data support both open and laparoscopic approaches for appendicitis. This case, although rare, highlights the importance of laparoscopy in a complete and thorough examination of the abdominal cavity. A standard right lower quadrant incision for an open technique would likely have resulted in omission of this lesion, and the patient would have presented at a more typical late stage of her cancer development with significantly more morbidity.
背景
脐尿管是膀胱顶部与脐之间的退化结构。肿瘤可起源于其残余组织，其中大多数为高分化黏液腺癌。脐尿管腺癌是一种极为罕见的肿瘤类型。
方法
我们报告一例51岁女性患者，因腹痛36小时前来我院就诊。患者因急性阑尾炎被送往手术室。行腹腔镜检查时，发现脓性渗出物和阑尾穿孔，同时在前腹壁发现一个肿块。基于肿块的位置，我们转为经腹正中切口的开腹手术，以治疗穿孔性阑尾炎并切除肿块。
结果
病理证实为穿孔性阑尾炎和黏液性脐尿管腺癌。
讨论
数据支持开腹和腹腔镜两种治疗阑尾炎的方法。该病例虽罕见，但凸显了腹腔镜检查在全面彻底检查腹腔方面的重要性。采用开腹技术的标准右下腹切口很可能会遗漏该病变，患者可能会在癌症发展的更典型晚期就诊，且发病率会显著更高。
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