RESUMO
Introducción. Durante el desarrollo embrionario normal, se espera que el denominado uraco o ligamento umbilical mediano se oblitere a las 32 semanas de gestación. Ante una obliteración incompleta surgen las diferentes anomalías, siendo las más frecuentes el quiste y la fístula urinaria umbilical. El objetivo de este artículo fue presentar el caso de una paciente joven, sin comorbilidades, con quiste de uraco. Caso clínico. Mujer indígena de 19 años que consultó por dolor leve en hipogastrio, asociado a síntomas urinarios y distensión abdominal. Se sospechó en primera instancia cólico renal, pero ante hallazgos ecográficos de masa infraumbilical y reactantes de fase aguda elevados, la impresión diagnóstica cambió a sepsis secundaria a absceso intraabdominal. Posterior a tomografía y cistoscopía con calibración uretral se identificó pequeño divertículo en cúpula vesical, que sugirió el diagnóstico de uraco persistente, por lo que la paciente fue llevada a intervención quirúrgica para su resección, con evolución favorable. Discusión. El quiste de uraco es una anormalidad infrecuente, en su mayoría asintomática y generalmente de hallazgo incidental en la población anciana, por lo que se requiere de imágenes y manejo multidisciplinar para su correcto diagnóstico y abordaje. Conclusión. Son pocos los casos de uraco persistente reportados, y mucho menos en el sexo femenino. Dada la posibilidad de complicaciones tardías es importante el seguimiento para su manejo. Este caso se ha controlado de manera ambulatoria por 2 años
Introduction. During normal embryonic development, it is expected that the so-called urachus or median umbilical ligament will be obliterated at 32 weeks of gestation. In the face of incomplete obliteration, the different anomalies of the urachus arise. The most frequent anomaly of the urachus is the cyst followed by the umbilical urinary fistula. The objective of this article was to present the case of a young patient without comorbidities with urachal cyst. Clinical case. A 19-year-old indigenous woman consulted for mild hypogastric pain associated with urinary symptoms and abdominal distension. Renal colic was suspected at first, but due to ultrasound findings of an infraumbilical mass and high acute phase reactants, the diagnostic impression changed to sepsis secondary to an intra-abdominal abscess. After tomography and cystoscopy with urethral calibration, a small diverticulum was identified in the bladder dome, suggesting a diagnosis of persistent urachus, for which the patient was taken to surgery for its resection, with favorable evolution. Discussion. The urachal cyst is a rare abnormality, mostly asymptomatic and usually incidental finding in the elderly population. Imaging and multidisciplinary management are required for its correct diagnosis and approach. Conclusion. There are few reported cases of persistent urachus and much less in females. Given the possibility of late complications, follow-up is important for its management, in this case we have carried out control for 2 years
Assuntos
Humanos , Anormalidades Congênitas , Úraco , Cisto do Úraco , Dor Abdominal , Abscesso Abdominal , CistoscopiaRESUMO
Las anomalías del uraco representan un bajo porcentaje de las patologías abdominales, no obstante, forman parte del diagnóstico diferencial del abdomen agudo por las complicaciones que puede tener. Aunque son de difícil diagnóstico debido a los síntomas inespecíficos, las imágenes diagnósticas son de gran utilidad para su identificación y caracterización. En pacientes con obesidad mórbida, la presentación del cuadro aumenta el riesgo de morbimortalidad. Por ende, en estos pacientes es necesario un control postoperatorio estricto para evaluar complicaciones secundarias a la resección del uraco. Dado los casos limitados en la literatura, se requieren estudios clínicos adicionales, para brindar un seguimiento adecuado, en aras de identificar complicaciones y el tratamiento precoz de estas
Urachal abnormalities represent a low percentage of abdominal pathologies; however, they are part of the differential diagnosis of acute abdomen due to the complications it may have. Although they are difficult to diagnose due to nonspecific symptoms, diagnostic images are especially useful for their identification and characterization. In patients with morbid obesity, the presentation of the picture increases the risk of morbidity and mortality. Therefore, in these patients, strict postoperative control is necessary to evaluate complications secondary to urachal resection. Given the limited cases in the literature, additional clinical studies are required to provide adequate diagnosis and follow-up in order to identify complications and their early treatment
Assuntos
Humanos , Obesidade Mórbida , Obstrução Intestinal , Cisto do Úraco , ÚracoRESUMO
Reporte de caso: La literatura manifiesta que el quiste de uraco es raro, por lo cual el diagnóstico es aún más difícil de establecer, debido a que solo se presentan síntomas cuando ya existe una complicación, por tanto se puede suponer que algunas personas sean poseedoras de un quiste de uraco y sin presentar sintomatología, siguen con sus actividades de la vida sin problemas. A continuación, presentamos el caso de una paciente, que ingreso con una clínica sugerente de abdomen agudo por apendicitis, pero los exámenes de imágenes revelaron otro diagnóstico, confirmándose con la intervención quirúrgica y posteriormente anatomía patológica. (AU)
Case report: The literature states that the urachus cyst is rare, so the diagnosis is even more difficult to establish, because symptoms only manifest when a complication already exists, so it can be assumed that many people have a urachus cyst, and without having symptoms, they continue with their life activities without problems. Next, we present the case of a patient, who admitted to a clinic suggestive of an acute abdomen due to appendicitis, but the imaging tests revealed another diagnosis, confirming with the surgical intervention and subsequently pathological anatomy. (AU)
Assuntos
Humanos , Feminino , Adulto , Apendicite , Cisto do Úraco/complicações , Diagnóstico Diferencial , Abdome Agudo/diagnósticoRESUMO
Background: The urachus is a tubular structure continuous with the urinary bladder and the allantois in foetal mammals.It serves as a communication between these two structures. At birth, it loses its function and undergoes atrophy by fibrousproliferation within the lumen. When this atrophy process fails at some point, congenital anomalies of the urachus occur.These anomalies are rare in animals, and to our knowledge, the urachal cyst has not yet been described in dogs. The presentwork is unique in that it reports a case of this congenital defect in a dog. Our aim is to increase awareness and to discussthe clinical presentation, the imaging techniques used, and the final diagnosis of this anomaly.Case: A 3-year-old bitch Pit Bull was presented for veterinary assistance to investigate recurrent pseudopregnancy and anirregular estrous cycle. The animal presented in good bodily condition, and the white blood count and clinical biochemistrywere normal. At ultrasound, 2 tubular structures, filled by an echogenic fluid mimicking uterine topography, were foundextending through the umbilical and hypogastric regions. No alterations in structure, echogenicity or echotexture of theother organs were observed, including the ovaries and uterus. On exploratory laparotomy, a cystic structure was found,with 2 segments: the larger one was on the left side, attached to the apex of the bladder by its caudal portion; the otherwas on the right side, attached to the spleen by its cranial portion and to the apex of the bladder by its caudal portion inconnection with the left segment. The ovaries, uterus and uterine horns showed no macroscopic alterations. The structurewas removed, and after analysis (macroscopic morphology, wall histopathology and biochemistry of the contained fluid),it was...(AU)
Assuntos
Animais , Feminino , Cães , Cisto do Úraco/patologia , Cisto do Úraco/veterinária , Anormalidades Congênitas/veterinária , Laparotomia/veterinária , Ultrassonografia/veterináriaRESUMO
Background: The urachus is a tubular structure continuous with the urinary bladder and the allantois in foetal mammals.It serves as a communication between these two structures. At birth, it loses its function and undergoes atrophy by fibrousproliferation within the lumen. When this atrophy process fails at some point, congenital anomalies of the urachus occur.These anomalies are rare in animals, and to our knowledge, the urachal cyst has not yet been described in dogs. The presentwork is unique in that it reports a case of this congenital defect in a dog. Our aim is to increase awareness and to discussthe clinical presentation, the imaging techniques used, and the final diagnosis of this anomaly.Case: A 3-year-old bitch Pit Bull was presented for veterinary assistance to investigate recurrent pseudopregnancy and anirregular estrous cycle. The animal presented in good bodily condition, and the white blood count and clinical biochemistrywere normal. At ultrasound, 2 tubular structures, filled by an echogenic fluid mimicking uterine topography, were foundextending through the umbilical and hypogastric regions. No alterations in structure, echogenicity or echotexture of theother organs were observed, including the ovaries and uterus. On exploratory laparotomy, a cystic structure was found,with 2 segments: the larger one was on the left side, attached to the apex of the bladder by its caudal portion; the otherwas on the right side, attached to the spleen by its cranial portion and to the apex of the bladder by its caudal portion inconnection with the left segment. The ovaries, uterus and uterine horns showed no macroscopic alterations. The structurewas removed, and after analysis (macroscopic morphology, wall histopathology and biochemistry of the contained fluid),it was...
Assuntos
Feminino , Animais , Cães , Anormalidades Congênitas/veterinária , Cisto do Úraco/patologia , Cisto do Úraco/veterinária , Laparotomia/veterinária , Ultrassonografia/veterináriaRESUMO
INTRODUCCIÓN: La patología por remanente de uraco representa un fracaso en el proceso de obliteración, es una anomalía rara congénita que se diagnostica en el 1.6 % de los niños menores a 15 años y en el 0.063 % de los adultos. CASO CLÍNICO: Paciente de 42 años, sexo masculino, intervenido por laparoscopía por apendicitis aguda complicada. Durante el procedimiento se encontró una masa a nivel de la pared abdominal anterior en contacto con la vejiga. Mediante exámenes complementarios se diagnosticó quiste de uraco. EVOLUCIÓN: Se planificó la exéresis del quiste de uraco por vía laparoscópica, el procedimiento se realizó sin complicaciones obteniéndose un quiste de 6 x 4 cm de diámetro, remanante del ligamento umbilical. No fue necesaria la resección de la cúpula vesical. El posquirúrgico evolucionó de manera favorable y el paciente se mantuvo hospitalizado durante 2 días antes de ser dado de alta. CONCLUSIÓN: La resolución laparoscópica es una técnica segura y efectiva de elección para la exéresis del quiste del uraco en adultos. Presenta ventajas en relación a la cirugía convencional por la disminución del riesgo de infección del sitio quirúrgico, disminuye el dolor posquirúrgico, disminuye la estancia hospitalaria y permite la reincorporación laboral temprana.(au)
BACKGROUND: Remnant urachal pathology represents an obliteration failure, it is a rare congenital anomaly diagnosed in 1.6 % of under 15-years and 0.063 % of adult patients. CASE REPORT: A 42-years old male patient who underwent laparoscopic surgery because of an acute complicated appendicitis. During procedure, a mass was found near to anterior abdominal wall, it had contact with the urinary bladder's wall. Complementary exams were performed and an urachal cyst w pically and was found to be an incidental mass at the level of the anterior abdominal wall in acontact with the bladder. Urachal cyst was diagnosed based on complementary studies. EVOLUTION: Laparoscopic exeresis of the urachal cyst was planned. The procedure had no complications and a 6 x 4 cm urachal cyst was obtained (umbilical ligament remnant). Urinary bladder's dome resection was not required. The postoperative was favorable and the patient stood hospitalized for 2 days before he was discharged. CONCLUSION: Laparoscopic resolution is a safe and effective technique to perform an urachal cyst exeresis in adults. It has some advantages over conventional surgery as lower surgical site infection risk, less postoperative pain, shorter hospital stay and early return to work.(au)
Assuntos
Humanos , Masculino , Adulto , Cisto do Úraco/cirurgia , Laparoscopia , Administração de CasoRESUMO
BACKGROUND: during gestation, the urachus represents the connection between the dome of the bladder and the allantoic duct. This infection occurs preferentially in young adults, advocating the haematogenous or lymphatic pathway as possible routes of transmission, while a cord or bladder origin may also occur. Urachal cysts are rare in adult life, and is observed in only about 2% of adults. CLINIC CASE: A 30-year-old male patient with a history of alcoholic hepatitis, diabetes mellitus type 2, chronic malnutrition, increased volume beginning with generalized abdominal pain, abdominal tumor of 20 by 15 cm, mobile, solid, without signs of peritoneal irritation. CT showed the presence of tumor, probably bladder-dependent, and apparently cystic. Exploratory laparotomy was found infected urachal cyst, draining 3,000 cc purulent material. A partial resection of the anterior face, keeping the back by firm adherence to bowel loops was done and is evolving satisfactorily. DISCUSSION: urachal abnormalities are rare, with male / female ratio of 2 / 1. Although urachal abscess is an infection confined to an enclosed space, definitive treatment should not be the simple incision and drainage, because of the possibility of malignant transformation of urachal remnants. The definitive treatment should be considered complete excision of urachal cyst, when the infection is limited. CONCLUSION: the urachus cyst is a rare pathology and is a diferencial diagnosis for acute appendicitis and it is necessary to know this treatment.
antecedentes: durante la gestación, el uraco representa la conexión entre la vejiga y el alantoides. Su infección se manifiesta, principalmente, en adultos jóvenes. La vía hematógena o linfática son las posibles rutas de trasmisión, aunque también puede ocurrir el origen umbilical o de vejiga. El quiste de uraco es raro en adultos y sólo puede observarse en 2%. Caso clínico: paciente masculino de 30 años, con antecedente de hepatopatía alcohólica, diabetes mellitus tipo 2, desnutrición crónica. Inició con aumento del volumen abdominal, dolor abdominal generalizado, tumor abdominal de 20 por 15 cm, móvil, de consistencia sólida, sin signos de irritación peritoneal.La tomografía computada mostró un tumor probablemente dependiente de la vejiga, de aspecto quístico. En la laparotomía exploradora se encontró un quiste de uraco infectado, que drenaba 3,000 cc de material purulento. Se realizó la resección parcial de la cara anterior y se conservó la posterior debido a la adherencia firme a las asas intestinales. La evolución postoperatoria fue satisfactoria. discusión: las alteraciones uracales son raras, con razón hombre:mujer de 2:1. Aunque un absceso uracal representa una infección confinada a un espacio cerrado, su tratamiento definitivo no debe ser la simple incisión y drenaje, debido a la posibilidad de degeneración maligna de los restos uracales. El tratamiento definitivo debe considerar la escisión completa del quiste, y del uraco, cuando la infección esté limitada. Conclusión: el quiste de uraco es una afección poco frecuente, que debe considerarse en el diagnóstico diferencial de apendicitis aguda, y tener en mente su tratamiento definitivo.
Assuntos
Abscesso Abdominal/etiologia , Cisto do Úraco/complicações , Abscesso Abdominal/cirurgia , Dor Abdominal/etiologia , Adulto , Apendicite/diagnóstico , Diabetes Mellitus Tipo 2/complicações , Diagnóstico Diferencial , Humanos , Hospedeiro Imunocomprometido , Laparotomia , Hepatopatias Alcoólicas/complicações , Masculino , Desnutrição/complicações , Cisto do Úraco/diagnóstico , Cisto do Úraco/embriologia , Cisto do Úraco/cirurgiaRESUMO
BACKGROUND: The urachal cyst is a rare pathology in the adult patient and in general is asymptomatic. The goal of this presentation is to learn of the errors. CLINICAL CASE: A 22 year old female with clinical diagnosis of acute appendicitis was taken to surgical management. Laparoscopy confirmed the diagnosis. Laparoscopic appendectomy was performed uneventfully. Four weeks in the postoperative period the patient developed reddening and softening in the left surgical wound which was a trocar incision. The initial diagnosis was a granuloma which was removed surgically twice. A fistulogram and abdominal CT scan were negative. Finally, we decided to perform a laparatomy trought the same incision and we found an infected urachal cyst, which was excised. A retrospective analysis of the laparoscopic appendectomy shows the urachal cyst and the perforation by the trocars. CONCLUSION: an inadequate process in the laparoscopic vision, in the diagnosis and technical errors were the cause of this chain of errors and a major temporal damage to this patient. An optimal laparoscopy would have detected the urachal cyst and treated of the two pathologies simultaneously. An adequate trocar placement would not have perforated the urachal cyst and therefore there would have been no postoperative symptoms. Finally open appendectomy could have avoided this chain of errors.