Author(s): McCollum MO, Macneily AE, Blair GK
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Abstract BACKGROUND/PURPOSE: The abdominal manifestations of urachal remnants often prompt referral to the pediatric general surgeon. The purpose of this study was to evaluate the authors' management of this anomaly. METHODS: The authors performed a retrospective review of patients presenting to their institution with urachal remnants between 1984 and 2001. Clinical and radiographic details of presentation, management, and outcomes are described. RESULTS: Twenty-six patients presented at a median age of 4 years (range, 2 days to 12 years), 16 were boys, and 18 required inpatient care. Eleven (42\%) presented with infection, 7 (27\%) with clear drainage, 3 (12\%) with umbilical polyps/granulation, 3 (12\%) with pain, one (4\%) with recurrent urinary tract infections, and one (4\%) with an asymptomatic punctum. One had an associated anomaly (hypospadias). Urinalysis and urine cultures did not correlate with infection. Ultrasound scan was diagnostic in greater than 90\% of cases. Overall, 20 patients underwent primary cyst excision, and 6 underwent incision and drainage (I&D) with delayed excision. Five patients underwent primary excision while infected, and 2 had postoperative complications (wound infection and urine leak). All 6 patients who underwent 2-stage procedure initially presented with infection, and none had complications. CONCLUSIONS: Persistent urachal remnants can present at any age with a variety of clinical manifestations. Ultrasound scan is a reliable diagnostic tool. Additional diagnostic studies generally are not warranted. Simple excision of noninfected lesions is appropriate. In cases of acute infection, initial I&D with delayed cyst excision may be preferable to avoid unnecessary complications. Copyright 2003 Elsevier Inc. All rights reserved.
This article was published in J Pediatr Surg
and referenced in Journal of Clinical & Experimental Pathology