Urachal Cysts: Symptoms, Diagnosis, and Treatment Options

Urachal tumor

My brother has been experiencing a high fever of 40 degrees Celsius for several days, and he has a pus-filled abscess in the lower left abdomen.
He was hospitalized on Tuesday for treatment (trying medication to see if it can reduce his body temperature).
On Wednesday, an emergency procedure was performed to drain the abdominal abscess.
By Thursday and Friday, his temperature fluctuated around 36-37.5 degrees Celsius, and he was no longer feverish.
A CT scan taken on Wednesday showed what the doctor described as a urachal cyst (the bladder appeared to have only a small issue, but the doctor did not measure its size).
Due to the large size of the abscess, they need to perform a surgery to remove the abscess membrane, which will involve an incision of 10-15 centimeters, along with the excision of the urachal cyst.
Additionally, there are abnormal liver function tests, and the doctor mentioned that there seems to be a shadow on the liver, which is concerning.
The attending physician's comments were quite alarming, suggesting I look up information online, but I found that the likelihood of malignancy seems high.
Later, another urologist examined him and noted that there was no hematuria or drainage from the umbilicus.
Our entire family is very anxious; he is scheduled for a cystoscopy on Tuesday and a colonoscopy on Wednesday.
I would like to know what the chances of recovery are.
The doctor mentioned that the abscess is too large for a simple debridement, and a 10-15 centimeter incision feels quite extensive.
The doctor said the surgery is significant, and my brother is only 34 years old.
We hope he can recover quickly.

Ku Le, 30~39 year old female. Ask Date: 2023/05/20

Dr. Chen Bingze reply Surgery

Hello, I believe your concerns are valid.
Your attending physician should be fully engaged in collaborating with other specialists to assist in your brother's treatment.
However, we may need to wait for the pathology report to determine the exact issue.

Reply Date: 2023/05/20

More Info

Urachal cysts are congenital anomalies that arise from the incomplete closure of the urachus, a structure that connects the bladder to the umbilicus during fetal development. While many individuals with urachal cysts remain asymptomatic, some may experience symptoms, particularly if the cyst becomes infected or inflamed. Symptoms can include abdominal pain, fever, and, in some cases, the presence of a palpable mass in the lower abdomen.
In your brother's case, the presence of a large abscess in the left lower abdomen, along with high fever, suggests that there may be an infection associated with the urachal cyst. The fact that he has been hospitalized and is undergoing treatment is crucial, as infections can lead to serious complications if not addressed promptly. The drainage of the abscess is a standard procedure to alleviate symptoms and prevent further complications.

The imaging findings you mentioned, which suggest a urachal cyst, indicate that the cyst is likely located near the bladder. The size of the cyst and the associated abscess may necessitate surgical intervention, especially if the cyst is large (as indicated by the need for a 10-15 cm incision). Surgical removal of the cyst and any associated infected tissue is often the most effective treatment to prevent recurrence and manage symptoms.
Regarding the concern about malignancy, while urachal remnants can potentially give rise to urachal carcinoma, this is relatively rare. The risk of malignancy increases if there are associated symptoms or if the cyst has been present for a long time without intervention. However, the presence of fever and abscess formation typically indicates an infectious process rather than malignancy. The upcoming cystoscopy and colonoscopy will help rule out any other underlying issues and provide a clearer picture of your brother's condition.

The prognosis for urachal cysts, especially when treated appropriately, is generally good. If the cyst is removed and any infection is adequately managed, most patients can expect a full recovery. It is essential to follow the recommendations of the healthcare team and to keep an open line of communication with the doctors regarding any concerns or questions about the treatment plan.

In summary, while the situation may seem daunting, especially with the size of the abscess and the surgical intervention required, the likelihood of a positive outcome is high with appropriate medical care. It is essential to remain hopeful and to support your brother through this challenging time. The medical team will monitor his progress closely and adjust the treatment plan as necessary to ensure the best possible outcome.

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