= Abstract =

A Clinical Study of Urachal Remnants

Chang Weon Cho, M.D., Jong In Lee, M.D., Poong Man Jung, M.D.

Department of Surgery, College of Medicine, Hanyang University

Seoul, Korea

The embryological and anatomical features of urachal anomalies have been well defined. Because of the variable clinical presentation, uniform guideline for evaluation and treatment are lacking. Although urachal remnants are rarely ob­served clinically, they often give rise to a number of problems such as infection and late malignant changes. Therefore, a total assessment of the disease with a particular focus on embryology, anatomy, clinical symptoms, as well as the most advisable management, is necessary. Twenty six patients with urachal remnants were treated at the Department of Pediatric Surgery from August 1980 to June 1998. Of these 26, 9 were classified as patent urachus 11 as urachal sinus, 4 as urachal cyst, 1 as urachal diverticulum and 1 as an alternating sinus. The group consisted of 11 males and 15 females. The age distribution was 20 neonates, 3 infants, 2 preschoolers and 1 adult. Infection was the most frequent complication and Staph. aureus was the predominant causative microorganism. Fistulogram was performed in 4 cases and ultrasound examination disclosed cysts or sinus in 7 cases. Excision was performed in 24 patients and incision and draniage in 2 cases as a primary treatment. There was no postopreative complication or recur­rence.

Index Words: Urachal remnant, Patent urachus, Urachal sinus, Urachal cyst, Urachal diver­

ticulum

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Table 1 . Age and Sex

< 1 m 1-6 m Type

M F M

Sinus 4 7

Patency 3 3 1

Cyst 1 2

Diverticulum 1

Alternating sinus

Total 8 12 2

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Table 2. Classification and Clinical Features

Case Age Sex Type Symptom Associated Anomalies Dx. tool Treatment

1 1 d M Patency Umbilical cord dilatation Imperforate anus IVP Excision

Discharge(urine) Single umbilical artery, VCUG

Meckel's diverticulum,

inguinal hernia

2 1 d F Patency Discharge( urine) Ischiopagus tetrapus, IVP Excision

imperforate anus, VCUG

single colon

3 10 d M Patency Discharge(urine) Umbilical hernia, VCUG Excision

. Meckel's diverticulum

4 20d F • Patency Discharge( urine) - Excision

5 20d M Patency Discharge(pus), redness, - Fistulogram Excision

pain, fever

6 27d F Patency Discharge(bloody & pus) Excision

7 3m F Patency Incidentally Colon atresia, Excision

Meckel's diverticulum

8 6m M Patency Discharge(urine), redness IVP Excision

9 40yr M Patency Discharge(bloody) Excision

10 13 d M Sinus Discharge, Patent umbilical artery US Excision

umbilical swelling and vein 11 13 d M Sinus Discharge (bloody ) Fistulogram Excision

12 15 d F Sinus Discharge, Imperforate hymen Excision

umbilical swelling Hemihypertrophy

13 16 d M Sinus Discharge, redness, pain Undescended testis Excision

Tongue tie 14 17 d M Sinus Discharge(pus ) - Excision

15 17 d F Sinus Discharge Excision 16 17 d F Sinus Discharge - Excision

17 18 d F Sinus Discharge, redness, se~ Umbilical vein remnant Fistulogram I&D

umbilical swelling, pain US Excision

18 20d F Sinus Discharge(pus ) - US Excision

19 28d F Sinus Discharge(pus), redness Hydronephrosis US Excision

20 30d F Sinus Discharge, redness US Excision

21 3d F Cyst Ma$, redness Excision

22 23d M Cyst Ma$, discharge (pus) Pyloric stenosis US Excision

23 15 d F Cyst Swelling, discharge - I&D

24 5yr F Cyst Mass US I&D

25 6m M Diverticulum Incidentally Imperforate anus, Excision

rectourethral fistula 26 6yr M Alternating Discharge(pus), abdominal - Fistulogram Excision

• pain, urinary difficulty IVP smus

Abbreviation; US : ultrasonogram, IVP; intravenous pyeloglllm, VCUG; voiding cystourethrogram I & D; incision and drainage

- 120-

Table 3. Associated Anomalies

Associated anomaly

Umbilical vessel anomaly

Meckel's diverticulum

Imperforate anus

Umbilical hernia

Hemihypertrophy

Colon atresia

Inguinal hernia

Hypertrophic pyloric stenosis

Undescended testis •

Ischiopagus tetrapus

Imperforate hymen

Tongue tie

Hydronephrosis

No. of cases*

3

3

2

2

1

1

1

1

1

1

1

1

1

* : Anomaly was associated in 10 patients

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Table 4. Bacteriologic Features of Umbilical Discharge (n=16*)

Case No. Type Cultured microorganism

2 Patency E. coli, E. fecalis

3 Patency S. au reus, P. aeruginosa, Enterococcus, Acinetobacler

4 Patency S. aureus, E .coli

5 Patency S. aureus

11 Sinus S. au reus, E. cloacae

13 Sinus S. aureus

15 Sinus S. aureus

17 Sinus S. aureus, E. coli

18 Sinus S. aureus

19 Sinus S. aureus

20 Sinus S. aureus

22 Cyst E. coli, E. fecalis

23 Cyst S. aureus

* : Case No.9, 14, 24 • No growth ,

- 121 -

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-T- ~~q.

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