Quinn Victoria, Luks Francois, Constantine Erika
Brown University Warren Alpert Medical School, Hasbro Children's Hospital, Department of Pediatrics, Providence, Rhode Island.
Brown University Warren Alpert Medical School, Hasbro Children's Hospital, Division of Pediatric Surgery, Providence, Rhode Island.
Clin Pract Cases Emerg Med. 2022 May;6(2):186-188. doi: 10.5811/cpcem.2022.1.55243.
A seven-year-old male presented to the pediatric emergency department with one day of abdominal pain. His physical exam was significant for rebound, guarding, and tenderness in the right lower quadrant, and his labs demonstrated a leukocytosis. Both a point-of-care ultrasound and radiology-performed ultrasound were concerning for acute appendicitis with a periappendiceal abscess, but on emergent laparoscopy the patient was found to have an infected urachal cyst.
Infected urachal remnants are a rare but important cause of pediatric abdominal pain. In this case, inflammation surrounding the patient's midline urachal cyst triggered a serositis that involved the appendix and pulled the cyst to the right. This created a clinical and radiologic presentation similar to appendicitis. This atypical presentation of an already rare anomaly highlights the importance of maintaining a broad differential during the work-up of pediatric abdominal pain.
一名7岁男性因腹痛一天就诊于儿科急诊科。他的体格检查显示右下腹有反跳痛、肌紧张和压痛，实验室检查显示白细胞增多。床旁超声和放射科进行的超声检查均提示急性阑尾炎伴阑尾周围脓肿，但在急诊腹腔镜检查中发现患者患有感染性脐尿管囊肿。
感染性脐尿管残余是小儿腹痛的一种罕见但重要的原因。在本病例中，患者中线脐尿管囊肿周围的炎症引发了浆膜炎，累及阑尾并将囊肿牵拉至右侧。这导致了类似于阑尾炎的临床和影像学表现。这种本就罕见的异常的非典型表现凸显了在小儿腹痛检查过程中保持广泛鉴别诊断的重要性。
