URACHAL CYST: AN UNSPECTED COMPLICATION

The urachus is the remnant of the allantois, which usually becomes obliterated shortly after birth. Urachal remnants due to an incomplete obliteration of different portion of the urachus are rare, but they need to be treated surgically because of their potential for infectious complications and malignant degeneration. We present a case report with an unespected post-operative complication. M.E., a 10 years old boy, came to the Accident and Emergency Department for an acute abdominal pain, without other symptoms, twice in one year. The blood tests, urine sample and voiding cystourethrogram were normal. The ultrasound scan showed a thickened urachal duct. After antibiotic and anti-inflammatory therapy for two weeks, we performed laparoscopic surgery. In the second postoperative day the patient showed abdominal pain and hematuria. An ultrasound scan and a voiding cystourethrogram showed a leak from the dome of bladder. We performed an open surgery to close the defect on the bladder’s dome. The patient was discharged in 10th postoperative day. Now he is healthy. Clinically manifest persistent urachal anomalies are rare, but they carry a risk of recurrent infection and subsequent malignant degeneration. For these reasons the radical excision of the remnant is suggested. Today, due to the large laparoscopic experience, all the reports showed that this technique can be used safely, but we have to pay attention to all steps of the procedure. This case is a paradigmatic situation and it illustrates the importance of a meticulous technique during the excision of urachal remnant. Indeed even if laparoscopic excision could be safe and effective, it is not free of complication.