QUIZ: No. 11, 11/05/2025

CASE 11

A 9-year-old male child presented with complaints of suprapubic pain. No significant medical and surgical history. CECT images are provided. What’s your diagnosis?

ANS – Infected Urachal Cyst

Findings: Midline cystic mass with associated thickening and surrounding minimal inflammation adjacent to the abdominal wall and urinary bladder.

The urachus is a ductal embryological remnant, originating from the involution of the allantois and cloaca and extending between the bladder dome and the umbilicus. Urachal anomalies result from the failure of the developing urachus to completely obliterate its lumen. A urachal cyst occurs when both ends of the canal close, but the central portion remains open. Urachal cysts usually become symptomatic when complicated. Many complications could occur including infection, progressive growth, intracystic bleeding, intraperitoneal rupture, bowel fistula and malignancy. The resection of the cyst wall entirely is especially recommended because of the high recurrence rate and the risk of malignancy.

Take home points

·   Infected urachal cyst should be considered in the differential diagnosis of an acute abdomen especially with a mass in the midline.