Congenital urachal anomalies
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Congenital urachal anomalies are a spectrum of potential anomalies that can occur due to incomplete involution of the urachus.
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A urachal remnant occurs in approximately 1 in 5000 patients.
The urachus connects the dome of the bladder to the umbilical cord during fetal life and is located behind the lower anterior abdominal wall and anterior to the peritoneum in the space of Retzius.
By birth, the urachus is obliterated and becomes a vestigial structure known as the median umbilical ligament (not to be confused with the medial umbilical ligament, which is a separate structure that lies laterally to the median umbilical ligament).
In the absence of complete obliteration, the urachus persists in a number of configurations depending on the location and degree of obliteration.
There are four types of congenital urachal remnant anomalies. They are:
- communication between the bladder and umbilicus through a urachus that has not involuted
- commonest (~50%)
- a fluid-filled dilatation of the mid urachus
- next commonest (~30%)
- blind focal dilatation of the umbilical end of the urachus
- blind focal dilatation of the bladder end of the urachus
Treatment and prognosis
Congenital urachal remnants predispose to infection from urinary stasis and over a long period the remnant may develop malignancy (e.g. adenocarcinoma).
Treatment is not standardized. Some recommend surgical excision of the urachus if a remnant anomaly is present.
- 1. Parada Villavicencio C, Adam SZ, Nikolaidis P, Yaghmai V, Miller FH. Imaging of the Urachus: Anomalies, Complications, and Mimics. Radiographics : a review publication of the Radiological Society of North America, Inc. 36 (7): 2049-2063. doi:10.1148/rg.2016160062 - Pubmed
- 2. Yu JS, Kim KW, Lee HJ et-al. Urachal remnant diseases: spectrum of CT and US findings. Radiographics. 21 (2): 451-61. Radiographics (full text) - Pubmed citation
- 3. Donnelly LF, Frush DP. Cross-sectional imaging of abnormalities of the abdominal wall in pediatric patients. AJR Am J Roentgenol. 2001;176 (5): 1233-9. AJR Am J Roentgenol (full text) - Pubmed citation
- 4. Disantis DJ, Siegel MJ, Katz ME. Simplified approach to umbilical remnant abnormalities. Radiographics. 1991;11 (1): 59-66. Radiographics (abstract) - Pubmed citation
- 5. Robert Y, Hennequin-Delerue C, Chaillet D, Dubrulle F, Biserte J, Lemaitre L. Urachal remnants: sonographic assessment. (1996) Journal of clinical ultrasound : JCU. 24 (7): 339-44. doi:10.1002/(SICI)1097-0096(199609)24:7<339::AID-JCU2>3.0.CO;2-C - Pubmed