Urachal Cyst, Meckel’s Diverticulum and Band, and Urachus

Dileep Garg1; Aditya Pratap Singh2; Sunil Kothari1; Ayush Kumar2

1. Department of Pediatric Surgery, SN Medical College Jodhpur, Rajasthan, India. , 2. Department of Pediatric Surgery, SMS Medical College Jaipur, Rajasthan, India.

Correspondence: Address for Correspondence:Dr. Aditya Pratap Singh, Department of Pediatric Surgery, SMS Medical College Jaipur, Rajasthan, India. E-mail:

Received: 2016 July 23; Accepted: 2016 October 19

APSP J Case Rep. 2017 Jan 5; 8(1): 8
doi: 10.21699/ajcr.v8i1.477

Copyright

Copyright © 2017 AJCR


Dear Sir,

A 4-year old boy presented with pain abdomen, bilious vomiting and constipation for three days. On examination, abdomen was distended and tender. X-ray abdomen revealed multiple air-fluid levels suggestive of intestinal obstruction. Ultrasonography abdomen revealed dilated bowel loops with minimal free fluid in peritoneal cavity. On exploration, there was a band causing obstruction of terminal ileum which was released. Band was arising from Meckel’s diverticulum which was connected to a cyst at umbilicus. On further exploration, the cyst was connected to urachus which was patent (Fig.1). There was no communication between bladder and urachus, cyst and urachus, Meckel's diverticulum and the cyst. Resection of Meckel’s diverticulum with ileum and end to end ileo-ileal anastomosis was done. Urachus and cyst were also excised. Patient recovered well postoperatively. Histopathology confirmed urachal cyst, urachus, and Meckel’s diverticulum.

Umbilicus is common passage for various structure during intrauterine life. These structures usually involute and their persistence result in a variety of anomalies at this site. Persistence of vitello-intestinal duct is common anomaly.[1] Urachal anomalies usually present as urachal sinus, patent urachus, or urachal cyst. Various authors have reported concurrent presence of both vitello-intestinal duct and urachal anomalies presenting with various features including intestinal obstruction and persistent discharge from the umbilicus.[2-5] Our case was unique as we found a Meckel’s diverticulum and a band which caused intestinal obstruction. Moreover, there was a urachal cyst at umbilicus which was attached to Meckel’s diverticulum on one side and to urinary bladder on other side through a patent tract which was not communicating with the urinary bladder. This was quite unusual.


[Figure ID: F1] Figure 1: Showing urachal cyst (UC) attached to Meckel’s diverticulum (MD) on one side and urinary bladder (UB) on other side with a patent tract- urachus (U).

Footnotes

Source of Support: Nil

Conflict of Interest: None declared


References
1. Griffith GL, Mulcahy JJ, McRoberts JW. Umbilical abnormalities. South Med J. 1979; 72:981-4.
2. Griffith GL, Mulcahy JJ, McRoberts JW. Patent urachal associated with completely patent omphalomesenteric duct. South Med J. 1982;75:25.
3. Nordholm-Carstensen A, Johansen LS. Intestinal obstruction caused by a Meckel’s diverticulum adherent to an infected urachal cyst. Ann Pediatr Surg. 2014;10:139-41.
4. Penninga L, Timmerman P, Reurings JC, Nellensteijn DR. Simultaneous occurrence of Meckel's diverticulum and patent urachus. BMJ Case rep.2015. bcr2015210147.
5. Ozel LZ, Talu M, User Y, Aydin N, Marur T. Coexistence of a Meckel's diverticulum and a urachal remnant. Clin Anat. 2005;18:609-12.

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