Hospital: Hospital Universitario Puerta del Mar.
Ciudad:
Nº:
Aut@r o Autores: L. Frápolli, J. Pardo, C. Garcia, A. Andueza.,
Presentación:
A 3 year-old child with right iliac fossa pain, fever, nausea and vomiting, came to Pediatric Emergency Department. Laboratory results showed leucocytosis and a raised CRP. Urinalysis was negative. An abdominal ultrasound scan was request due to appendicitis suspicion. The examination showed two main radiological findings (Figure 1): -The presence of a mass of heterogeneous echogenicity (red arrow), which presented thick wall, cystic areas inside, and inflammatory changes of the surrounding fat. The mass was located in the anterior abdominal wall in the midline, near the dome of the bladder. It had not connections with the bladder or umbilicus, therefore it was diagnosed as an infected urachal cyst. -The second radiological finding was “donut-like” image (yellow arrow) located in the right iliac fossa. This mass had alternating hyperechoic and hypoechoic concentric layers and multiple adenopathies were surrounding it. The patient was sedated for intussusception reduction with water-soluble medium. Spontaneous resolution was produced by sedation. The infectious urachal cyst was treated with parenteral antibiotic and the patient became asymptomatic in five days. Surgery was done two months later and the diagnosis of urachal remnant was confirmed.
Discusión:
The urachus is a structure that usually closes before birth, forming the median umbilical ligament that extends from the umbilicus to the anterior dome of the bladder. The incomplete regression of urachus results in four types of congenital urachal anomalies: patent urachus (50%), urachal cyst (30%), umbilical-urachal sinus (15%) and vesicourachal diverticulum (5%). (1) Urachal cyst appears when the urachus remains patent between two end points with no connection to the bladder or umbilicus, as shown in our case. Ultrasound shows a fluid-filled cavity in the midline lower abdominal wall. The infection is the most common complication of urachal cyst. It manifests as wallthickening and soft-tissue components and mixed echogenicity at ultrasound scan. (1) Intussusception is a medical condition in which a part of the intestine folds into the section immediately ahead of it. In children ileocolic intussusception is the most common type. The etiology of intussusception in children is typically idiopathic, often influenced by anatomic or infectious factors. (2) The presence of adenopathies in the context of infectious disease is another common cause of pediatric intussusception because these adenopathies can act as a lead point. The classic manifestation of intussusception on ultrasound scan is the “donut sign” which represents layers of the intestine within the intestine.(2) In our patient, two different radiological findings, an infected urachal cyst and an ileocolic intussusception, could justify the abdominal pain. Therefore, we present an atypical clinical case, in which two diagnoses are made at the same time. In the context of an infected urachal cyst, there are multiple reactive adenopathies, which may have contributed to the development of intussusception.
Conclusión:
The urachus is a structure that usually closes before birth, forming the median umbilical ligament that extends from the umbilicus to the anterior dome of the bladder. The incomplete regression of urachus results in four types of congenital urachal anomalies: patent urachus (50%), urachal cyst (30%), umbilical-urachal sinus (15%) and vesicourachal diverticulum (5%). (1) Urachal cyst appears when the urachus remains patent between two end points with no connection to the bladder or umbilicus, as shown in our case. Ultrasound shows a fluid-filled cavity in the midline lower abdominal wall. The infection is the most common complication of urachal cyst. It manifests as wallthickening and soft-tissue components and mixed echogenicity at ultrasound scan. (1) Intussusception is a medical condition in which a part of the intestine folds into the section immediately ahead of it. In children ileocolic intussusception is the most common type. The etiology of intussusception in children is typically idiopathic, often influenced by anatomic or infectious factors. (2) The presence of adenopathies in the context of infectious disease is another common cause of pediatric intussusception because these adenopathies can act as a lead point. The classic manifestation of intussusception on ultrasound scan is the “donut sign” which represents layers of the intestine within the intestine.(2) In our patient, two different radiological findings, an infected urachal cyst and an ileocolic intussusception, could justify the abdominal pain. Therefore, we present an atypical clinical case, in which two diagnoses are made at the same time. In the context of an infected urachal cyst, there are multiple reactive adenopathies, which may have contributed to the development of intussusception.
Bibliografía:
-Qureshi K, Maskell D, McMillan C, Wijewardena C. An infected urachal cyst presenting as an acute abdomen – A case report. Int J Surg Case Rep. 2013, 4: 633–635. – Marsicovetere P, Ivatury SJ, White B, Holubar SD. Intestinal Intussusception: Etiology, D