Abstract
Infection of urachal remnant may cause recurrent abscesses. In the
current case report, we describe an urachal remnant infection leading to
a retroperitoneal abscess, which is extremely rare condition. In such
cases, the recommended treatment is urachal remnant resection.
Keywords: retroperitoneal abscess, urachal remnant, ureteral
resection
Case presentation
Abscess formation due to infection of urachal remnants is usually
localized. A retroperitoneal abscess resulting from such infection is
quite rare. [1] [2].
A 65-year-old man with fever and abdominal pain was admitted to our
hospital.
Upon computed tomography (CT), we observed gas and extensive abscess
formation in the preperitoneal space from the lower abdomen to the
pelvis (Fig 1A). We performed emergency laparotomy. Laparoscopic
examination of the abdominal cavity revealed no obvious perforation of
the gastrointestinal tract and no obvious abscess formation; however,
there was marked swelling of the abdominal wall centered on the midline
umbilical cord, suggesting abscess formation in the same area (Fig 1B).
Through a midline incision in the lower abdomen, the Retzius cavity was
opened and cleaned, and a drainage tube was placed. On follow-up at 4-6
months postoperatively, a recurrence of retroperitoneal abscess was
observed. The patient underwent CT-guided drainage of this new abscess.
CT contrast scan showed a slightly hyperdense cord-like structure
extending from the umbilical region to the bladder, which was assumed to
be a urachal remnant (Fig 1C). This led us to the conclusion that the
abscess must have formed in this urachal remnant, subsequently spreading
to the retroperitoneum. Hence, we decided to resect this urachal
remnant. A laparoscopic ureteral remnant resection was performed. The
median cord, i.e., the presumed urachal remnant, was detached from the
abdominal wall (Fig 1D).