Infected urachal cyst
24 year old patient with lower abdominal pain and elevated inflammatory parameters. She was treated with antibiotics (with partial response). US described ovarian cyst. In the past, she underwent surgery for appendicitis.
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Septated cystic formation with thick enhancing walls in the urachus with reaction of the surrounding parietal peritoneum - finding corresponds morphologically with an infected urachal cyst.
The urachus is a fibrous bundle as a relic of the urogenital tract during development. It is located between the parietal peritoneum and transverse muscle fascia and extends from the apex of the bladder to umbilicus. The incidence of developmental urachal abnormalities is 1:5000 and is more common in men (3:1).
Infected urachal cyst can occur in childhood, but as well in adulthood and becomes associated with various complications. It can be drained through umbilicus, bladder or through the peritoneum and into intraperitoneal organs. Rarely it can cause peritonitis and abdominal symptoms. In differential it is necessary to exclude malignant adenocarcinoma.
The most common pathogens of urachal abscess are Staphylococcus, E. coli, Pseudomonas, and Streptococcus.
Treatment consists of IV antibiotic therapy and surgical excision. Drainage is usually associated with a high rate of relapse. Sometimes it is advisable to drain the cyst contents before its excision.