Urachal anomalies: ultrasonography and management

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Abstract

Background: Fifty-six children with anomalies of the urachus remnant identified by ultrasound scan have been encountered in the authors’ hospital over the last 4 years.

Methods Twenty of these 56 cases were symptomatic urachal remnants, whereas the urachus remnants were seen incidentally by ultrasound scanning in the other 36 patients. Symptomatic cases were treated with antibiotics or observation. Then, symptomatic cases were divided into 2 groups. One group, surgical group, was treated with surgical resection of the urachal remnant. The other group, observation group, was followed up without its surgical resection. Forty-four patients, 11 cases of symptomatic urachal remnant and 33 asymptomatic cases, were followed up, excluding patients who had surgical treatment and who were lost to follow-up.

Results Thirty patients underwent periodical ultrasonographic examination during follow-up. In 9 cases, including 2 symptomatic cases, urachal remnants have disappeared during the follow-up period spontaneously. No symptom had developed during follow-up from asymptomatic cases.

Conclusions The patients with asymptomatic urachal remnants do not require follow-up, and urachal remnants, especially those under 1 year of age, do not require surgical resection unless the patient has multiple episodes.

Section snippets

Materials and methods

The reported cases were gathered from patients with or without symptoms who underwent an abdominal ultrasound examination in our hospital. The lower abdominal wall of consecutive children was examined with a real-time ultrasound 3.5-MHz convex probe (Aroca) with any detected lesions being examined with a 7.5-MHz anura alley transducer (Aroca; Tokyo, Japan). Midline hypoechoic lesions posterior to the rectus abdominis muscle and ventral to the apex of the bladder were identified as the urachus

Sonography

Ultrasonography detected 56 urachal remnants during the 4-year period. Children with urachal remnant detected by ultrasound scan were treated if necessary and observed. Ultrasonography was carried out for diagnosis of patient’s complaints in 40 patients (71%), and for follow-up for other diseases in 16 cases (29%) when their urachal remnants were found. The urachal remnant was believed to be the underlying cause of the symptoms in 20 cases of the 40 patients. In the remaining patients, the

Discussion

According to Begg,1 the persistence of the urachus was described and treated for the first time in 1550 by Bartholomaeus Cabrolius. The urachus is an allantoic remnant that is located between the umbilicus and the dome of the bladder. It lies in the space of Retzius behind the transversalis fascia and anterior to the peritoneum. Usually, the lumen is obliterated during fetal life, and the remnant forms the median umbilical ligament. However, a vestigial small lumen lined by transitional

References (10)

  • M. Blichert-Toft et al.

    Diseases of the urachus simulating intra-abdominal disorders

    Am J Surg

    (1971)
  • R.C. Begg

    The urachusIts anatomy, histology and development

    J Anat

    (1930)
  • M. Blichert-Toft et al.

    Congenital patent urachus and acquired variants

    Acta Chir Scand

    (1971)
  • E.G. Schubert et al.

    Tubular urachal remnants in adult bladders

    J Urol

    (1981)
  • A.A. Cacciarelli et al.

    Urachal remnantsSonographic demonstration in children

    Radiology

    (1990)
There are more references available in the full text version of this article.

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