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André TOJAL

Centro Hospitalar Tondela-Viseu
Viseu, Portugal
MD
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Laparoscopic excision of urachal cyst - a minimally invasive approach of a rare cause of abdominal pain in adults
Congenital abnormalities of the urachus are rare, with an incidence of 2:300000 children and 1:5000 adults. The urachus is a fibrous remnant of the allantois, usually occluded in the 4-5th gestational months, with the descent of the bladder towards the pelvis. It lies in the space of Retzius, between the transverse fascia anteriorly and the peritoneum posteriorly. The absence of its obliteration can result in an urachal cyst in 36% of cases. The main complication of the cyst is focal infection with associated risks of rupture and intestinal involvement. Diagnosis relies on clinical history, abdominopelvic ultrasonography and CT-scan. The treatment consists in complete excision of abnormal tissue and a small portion of adjacent bladder wall, therefore reducing the risk of malignant degeneration of the entire remnant.
A twenty-year-old healthy woman was referred to the emergency department with localized discomfort and a foul smelling purulent discharge from the umbilicus with three days of evolution. The patient was afebrile with periumbilical inflammatory signs, without signs of peritoneal irritation on physical exam. Blood tests were all normal, apart from a raised C-reactive protein (2.52mg/dL). Abdominal ultrasound was suggestive of an infected urachal cyst with umbilical fistulization. Empirical treatment with antibiotics was started and an abdominopelvic CT-scan, made as outpatient surgery, showed a probable 26mm urachal cyst, posterior and adjacent to the umbilicus, without bladder attachment.
The patient was treated surgically with a laparoscopic excision of the remainder of the urachus, without intraoperative complications. A good clinical evolution was observed during the hospital stay, and the patient was discharged on the fourth postoperative day. On follow-up, the patient did not complain of anything.
This clinical case emphasizes the importance of the high index of diagnostic suspicion in the management and treatment of the rare causes of abdominal pain, often with the possibility of a minimally invasive approach.
A Tojal, AR Loureiro, B Prata, R Patrão, N Carrilho, C Casimiro
Surgical intervention
2 months ago
830 views
3 likes
1 comment
10:34
Laparoscopic excision of urachal cyst - a minimally invasive approach of a rare cause of abdominal pain in adults
Congenital abnormalities of the urachus are rare, with an incidence of 2:300000 children and 1:5000 adults. The urachus is a fibrous remnant of the allantois, usually occluded in the 4-5th gestational months, with the descent of the bladder towards the pelvis. It lies in the space of Retzius, between the transverse fascia anteriorly and the peritoneum posteriorly. The absence of its obliteration can result in an urachal cyst in 36% of cases. The main complication of the cyst is focal infection with associated risks of rupture and intestinal involvement. Diagnosis relies on clinical history, abdominopelvic ultrasonography and CT-scan. The treatment consists in complete excision of abnormal tissue and a small portion of adjacent bladder wall, therefore reducing the risk of malignant degeneration of the entire remnant.
A twenty-year-old healthy woman was referred to the emergency department with localized discomfort and a foul smelling purulent discharge from the umbilicus with three days of evolution. The patient was afebrile with periumbilical inflammatory signs, without signs of peritoneal irritation on physical exam. Blood tests were all normal, apart from a raised C-reactive protein (2.52mg/dL). Abdominal ultrasound was suggestive of an infected urachal cyst with umbilical fistulization. Empirical treatment with antibiotics was started and an abdominopelvic CT-scan, made as outpatient surgery, showed a probable 26mm urachal cyst, posterior and adjacent to the umbilicus, without bladder attachment.
The patient was treated surgically with a laparoscopic excision of the remainder of the urachus, without intraoperative complications. A good clinical evolution was observed during the hospital stay, and the patient was discharged on the fourth postoperative day. On follow-up, the patient did not complain of anything.
This clinical case emphasizes the importance of the high index of diagnostic suspicion in the management and treatment of the rare causes of abdominal pain, often with the possibility of a minimally invasive approach.
A rare cause of abdominal pain (liposarcoma) treated by a minimally invasive approach
A 53-year-old woman is referred to the emergency department with complaints of an insidious pain in the left lower abdominal quadrant, with no associated fever, neither changes in her bowel habits, nor other complaints. She had a cardiac arrhythmia, medicated with atenolol, and no previous surgeries. Laboratory results showed no significant changes. Abdominal ultrasound demonstrated an inflammatory mass adjacent to the left colon. The abdominal and pelvic CT-scan showed a bulky and capsulated mass at the left iliac fossa extending along the left flank until the lower pole of the left kidney, measuring 9x12x20cm, probably corresponding to a peritoneal lipoma, with no signs of aggressiveness towards adjacent organs. The patient was admitted to hospital for clinical vigilance and complementary exams. Upper and lower endoscopic studies were performed and revealed no significant changes. The patient was then proposed for elective surgery – laparoscopic excision of the intra-abdominal mass, which was independent of the intra-abdominal visceral content. In the postoperative period, the patient had no complications with clinical discharge four days after surgery. The pathology report revealed a well-differentiated lipomatous neoplasia, a lipoma-like liposarcoma. In a multidisciplinary meeting, it was decided not to perform any adjuvant treatment. The patient remains with neither clinical nor imaging signs of the disease after 10 months of follow-up.
A Tojal, J Marques, S Coelho, M Fernandes, N Carrilho, H Oliveira, C Casimiro
Surgical intervention
1 year ago
1006 views
63 likes
0 comments
07:41
A rare cause of abdominal pain (liposarcoma) treated by a minimally invasive approach
A 53-year-old woman is referred to the emergency department with complaints of an insidious pain in the left lower abdominal quadrant, with no associated fever, neither changes in her bowel habits, nor other complaints. She had a cardiac arrhythmia, medicated with atenolol, and no previous surgeries. Laboratory results showed no significant changes. Abdominal ultrasound demonstrated an inflammatory mass adjacent to the left colon. The abdominal and pelvic CT-scan showed a bulky and capsulated mass at the left iliac fossa extending along the left flank until the lower pole of the left kidney, measuring 9x12x20cm, probably corresponding to a peritoneal lipoma, with no signs of aggressiveness towards adjacent organs. The patient was admitted to hospital for clinical vigilance and complementary exams. Upper and lower endoscopic studies were performed and revealed no significant changes. The patient was then proposed for elective surgery – laparoscopic excision of the intra-abdominal mass, which was independent of the intra-abdominal visceral content. In the postoperative period, the patient had no complications with clinical discharge four days after surgery. The pathology report revealed a well-differentiated lipomatous neoplasia, a lipoma-like liposarcoma. In a multidisciplinary meeting, it was decided not to perform any adjuvant treatment. The patient remains with neither clinical nor imaging signs of the disease after 10 months of follow-up.