Introduction: Urachus anomalies are remnants of the urachus, an embryonic connection between the fetal bladder and umbilicus. These anomalies usually remain asymptomatic but can cause symptoms in case of infection. An extremely rare complication of symptomatic urachal remnants is fistulizing to adjacant viscera. We describe the first case of diverticulitis associated sigmoid-urachal-cutaneous fistula.
Case Report: An 88-year-old male visited the outpatient clinic with intermittent bleeding and gassy discharge from his umbilicus. Examination showed a normal looking umbilicus with a small fissure at the bottom in which a 10 cm probe could be inserted. Laparotomy revealed a fistula extending from the umbilicus to a pus filled cyst superior to the bladder. A second fistula between the cyst and a mid-sigmoid diverticulum was identified. The involved sigmoid segment was resected. Pathological examination demonstrated no malignancy.
Discussion: Urachal remnants are extremely rare in adults. They typically present with abdominal pain or palpable masses. Additional imaging can aid the diagnostic process.
Conclusion: Due to the risk of recurrence and malignant transformation complete surgical excision of urachal anomalies is the treatment of choice. This can be done in a 1-step or 2-step procedure.
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http://dx.doi.org/10.1016/j.ijscr.2011.10.013 | DOI Listing |
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Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
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Acute aortic syndromes (AAS) include life-threatening conditions like penetrating atheromatous ulcer (PAU), which occurs when an atherosclerotic plaque erodes through the aortic wall. This can lead to complications such as intramural hematoma, pseudoaneurysm, or aortic rupture, especially in the ascending aorta. PAUs typically affect older males with atherosclerosis and are most commonly found in the lower descending thoracic aorta, with multiple PAUs being rare.
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Department of Stomatology, Research Group GIU21/042, University of the Basque Country/EHU, Leioa, Spain.
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Department of Osteopathic Manipulative Medicine, Liberty University College of Osteopathic Medicine, Lynchburg, USA.
An 88-year-old male with a history of cervical spondylosis (status post laminectomy of C2-C3 and laminoplasty of C4-C5), chronic congestive heart failure (CHF), pulmonary embolism, and lumbar spinal stenosis presented to an outpatient sports medicine clinic with neck pain following a fall five days prior due to loss of balance. He reported pain on the left side worsened by movement and accompanied by neck "clicking." A physical exam showed severe limitation in cervical spine extension limited by pain and loss of lordotic curve and a neurologic exam demonstrated weakness in the left leg secondary to a previous back surgery.
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Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA.
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