Peters Anna L, Kruijer Marjan J P, Wiese Hans, Verbeek Paul C M
University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
Int J Surg Case Rep. 2012;3(2):55-8. doi: 10.1016/j.ijscr.2011.10.013. Epub 2011 Nov 3.
Urachus anomalies are remnants of the urachus, an embryonic connection between the fetal bladder and umbilicus. These anomalies usually remain asymptomatic but can cause symptoms in case of infection. An extremely rare complication of symptomatic urachal remnants is fistulizing to adjacant viscera. We describe the first case of diverticulitis associated sigmoid-urachal-cutaneous fistula.
An 88-year-old male visited the outpatient clinic with intermittent bleeding and gassy discharge from his umbilicus. Examination showed a normal looking umbilicus with a small fissure at the bottom in which a 10 cm probe could be inserted. Laparotomy revealed a fistula extending from the umbilicus to a pus filled cyst superior to the bladder. A second fistula between the cyst and a mid-sigmoid diverticulum was identified. The involved sigmoid segment was resected. Pathological examination demonstrated no malignancy.
Urachal remnants are extremely rare in adults. They typically present with abdominal pain or palpable masses. Additional imaging can aid the diagnostic process.
Due to the risk of recurrence and malignant transformation complete surgical excision of urachal anomalies is the treatment of choice. This can be done in a 1-step or 2-step procedure.
脐尿管异常是脐尿管的残余物，脐尿管是胎儿膀胱与脐之间的胚胎连接结构。这些异常通常无症状，但在发生感染时可引发症状。有症状的脐尿管残余物极为罕见的一种并发症是与相邻脏器形成瘘管。我们报告首例乙状结肠 - 脐尿管 - 皮肤瘘合并憩室炎的病例。
一名88岁男性因脐部间歇性出血和排气就诊于门诊。检查发现脐外观正常，底部有一小裂缝，可插入一根10厘米的探针。剖腹探查显示有一个瘘管从脐延伸至膀胱上方一个充满脓液的囊肿。在囊肿与乙状结肠中段憩室之间发现了第二个瘘管。切除受累的乙状结肠段。病理检查未发现恶性病变。
脐尿管残余物在成人中极为罕见。它们通常表现为腹痛或可触及的肿块。进一步的影像学检查有助于诊断过程。
由于存在复发和恶变风险，脐尿管异常的彻底手术切除是首选治疗方法。这可以通过一步或两步手术完成。
