Palpable abdominal mass persisting for a long time: a case report

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.