Infected Urachal Cyst: An Unusual Cause of Small Bowel Obstruction in a Two-Year-Old
Author(s):
Andrew Wang, Naval Medical Center San Diego; Jonathan Halbach, Naval Medical Center San Diego; Erin Ward, University of California San Diego; Denise Malicki, Rady Children's Hospital San Diego, CA; Hariharan Thangarajah, Rady Children's Hospital San Diego, CA
Background: Urachal cysts typically remain asymptomatic unless they become infected. They present most commonly in children as a painful periumbilical mass. We report a case of an infected urachal cyst presenting as a small bowel obstruction.
Hypothesis: Case Report.
Methods: A two-year-old male presented with abdominal pain, nausea, vomiting, and obstipation. On exam, his abdomen was distended and a modest erythematous bulge was noted along the inferior margin of the umbilicus. Laboratories demonstrated a normal WBC and elevated CRP. An ultrasound showed a heterogeneous, echogenic mass just deep to the mid abdominal wall. CT imaging was interpreted as demonstrating an incarcerated umbilical hernia versus an infected urachal remnant. He was taken to the operating room for abdominal exploration, where an infected urachal cyst was discovered. Small intestine was tethered to the inflamed peritoneum overlying the cyst, resulting in a bowel obstruction. The obstruction was relieved and the cyst resected. The patient recovered uneventfully.
Results: Contemporary management of an infected urachal cyst typically involves antibiotic therapy and percutaneous drainage, followed by interval excision. The case presented here required urgent surgical intervention due to the presence of a small bowel obstruction. The culprit was ultimately found to be an infected urachal cyst with small bowel adherent to the overlying peritoneum. Bowel obstructions due to mechanical compression from an urachal remnant are rare, but have been reported previously in both adults and children. Obstruction due to peritoneal inflammation from an infected urachal cyst has been documented in adults, but has not previously been reported in the pediatric population.
Conclusions: An infected urachal cyst is a rare cause of small bowel obstruction that should be considered in the differential diagnosis for a pediatric patient presenting with the appropriate signs and symptoms.