Palpable abdominal mass persisting for a long time: a case report
Date Issued
2022-09-30
Author(s)
Kjamili, Jeton
Janchulev, Josif
Lozanovski, Vladimir
Saliu, Afrim
Petkovski, Pece
Abstract
Introduction: The urachus is the remnant of the connection between the urinary
bladder and the allantois. Rarely, the urachus partially obliterates or reopens
under pathological circumstances. Pathology of the urachus in adults is rare but
often manifests as an acute abdomen, umbilical infection, or fistula. We present
a case of inflamed urachus sinus and cyst presenting as a tumorous abdominal
mass that infiltrate the nearby organs
Case report: A 67-year-old patient was referred to our urology clinic with a
complaint of pneumaturia and presence of an abdominal mass for one year.
On clinical examination, a palpable painless mass was present suprapubically
to the right. There were no skin changes. There were no previous operations,
nor more serious chronic diseases. Laboratory tests, including tumor markers,
were unremarkable. Computer tomography (CT) revealed air in the bladder
and suspected vesicointestinal fistula. A voiding urethrocystography revealed
no fistulous channel, but only air in the bladder. A colonoscopy was performed
and hypertrophic valvula Bauhini was observed. A cystoscopy with transurethral
resection was performed on the abnormal mucosa on the right side of the
vertex and histopathological analysis (HPA) revealed chronic cystitis and urachus
fragments. The patient was prescribed antibiotic therapy for one month, and
there was mass reduction and clinical improvement but no complete resolution.
It was decided to proceed with a laparotomy. Total tumor removal with a partial
cystectomy, hemicolectomy, also a lymphadenectomy was performed. HPA
revealed phlegmonous urachal sinus and urachal cyst with inflammatory changes
of the urinary bladder, terminal ileum, caecum, appendix, ascending colon and
right ovary.
Conclusion: Adult urachal abnormalities are uncommon, yet because of their
various clinical manifestations, they are frequently misdiagnosed. Planning the
right surgical treatment with the assistance of an early diagnosis helps lower
morbidity.
bladder and the allantois. Rarely, the urachus partially obliterates or reopens
under pathological circumstances. Pathology of the urachus in adults is rare but
often manifests as an acute abdomen, umbilical infection, or fistula. We present
a case of inflamed urachus sinus and cyst presenting as a tumorous abdominal
mass that infiltrate the nearby organs
Case report: A 67-year-old patient was referred to our urology clinic with a
complaint of pneumaturia and presence of an abdominal mass for one year.
On clinical examination, a palpable painless mass was present suprapubically
to the right. There were no skin changes. There were no previous operations,
nor more serious chronic diseases. Laboratory tests, including tumor markers,
were unremarkable. Computer tomography (CT) revealed air in the bladder
and suspected vesicointestinal fistula. A voiding urethrocystography revealed
no fistulous channel, but only air in the bladder. A colonoscopy was performed
and hypertrophic valvula Bauhini was observed. A cystoscopy with transurethral
resection was performed on the abnormal mucosa on the right side of the
vertex and histopathological analysis (HPA) revealed chronic cystitis and urachus
fragments. The patient was prescribed antibiotic therapy for one month, and
there was mass reduction and clinical improvement but no complete resolution.
It was decided to proceed with a laparotomy. Total tumor removal with a partial
cystectomy, hemicolectomy, also a lymphadenectomy was performed. HPA
revealed phlegmonous urachal sinus and urachal cyst with inflammatory changes
of the urinary bladder, terminal ileum, caecum, appendix, ascending colon and
right ovary.
Conclusion: Adult urachal abnormalities are uncommon, yet because of their
various clinical manifestations, they are frequently misdiagnosed. Planning the
right surgical treatment with the assistance of an early diagnosis helps lower
morbidity.
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