A 74-year-old man presented to the emergency department with hypogastric pain, fever and dysuria for 48 hours.
His personal history included hypertension treated with captopryl, hyperlipemia treated with atorvastatin and hyperuricemia treated with allopurinol.
Physical examination revealed a palpable, painful, large mass occupying hypogastrium and both iliac fossae.
Blood analysis showed 25,930 leukocytes with marked left shift and analysis of urine sediment 3-5 leukocytes/field, microhematuria with positive nitrites in the reagent strip.
An abdominal ultrasound is requested to report a possible hypogastric abscess of 15 x 9.2 x 7.3 cm. The study is completed with a sentinel abdominal-pelvic CT scan showing an ileocaecal abscess with a bladder area of 8 cm.
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With the diagnostic hypothesis of infected urachal cyst, percutaneous drainage was performed with sampling for microbiology and intravenous broad-spectrum antibiotics were established.
Serial cultures isolated Leuconostoc spp, Streptococcus intermedius, Clostridium perfringens, Escherichia Coli, Baoides ovatus, Corynebacterium spp. and Pseudomonas aeruginosa.
During admission, the study was completed with a new CT, which does not provide new information with respect to the previous one; opaque enema, which does not provide information on the origin of the cyst is observed colonic mucosa without objective alteration.
Once the study was completed, an exploratory laparotomy was performed.
After performing a midline laparotomy, an independent bladder mass was observed, intensely adhered to the intestinal loops and cecum.
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Exeresis was performed, resulting in the accidental opening of the lesion, leaving mucoid material outdoors, which was sent for intraoperative pathological study, ruling out malignancy.
Subsequently, an ilio-ceco-icular lymphadenectomy (with intraoperative diagnosis by freezing of absence of malignancy) and segmental resection plus cecal abscess was performed.
The final pathological diagnosis is mucinous cystadenoma (mucocele) associated with malformations.
The postoperative period was favorable, except for presenting infection of the surgical wound, being discharged one month after surgery.
The patient had an independent life and was asymptomatic until one year after surgery, when he died due to sudden death of cardiac origin.
