Case of Urachal Cyst: A Rare Anomaly

Urachal abnormalities result from incomplete regression of the foetalurachus. They are more common in children than in adults, due to urachal obliteration in early infancy. A 32 year old male presented to surgical department with a 3 months history of foul smelling purulent umbilical discharge associated with constant lower abdominal pain, low grade fever without chills and rigors. A midline incision was used to excise the cyst, together with the omentum adherent to it posteriorly. Histopathological analysis of the resected specimen showed chronic inflammation with no evidence of malignancy. Urachal diverticulum seems to be the rarest of the anomalies in all series, with some recent series not reporting any. Urachal anomalies are rare in adults. Presentation is atypical, therefore, a high index of suspicion is required in order to achieve a diagnosis. A triad of lower midline mass, umbilical discharge and sepsis is suggestive, although MRI confirms the diagnosis and defines the surrounding anatomical relationship. Complete surgical excision is the treatment of choice due to the risk of malignant transformation. We recommend a 2 stage treatment with a combination of broad spectrum antibiotics or incision and drainage, followed by interval excision after resolution of sepsis.