A 7-year-old girl with no medical or surgical history except for several episodes of acute urticarial irritation at birth, 1 year of life and the last 6 months ago presented to the emergency department with bladder pain C.
Physical examination showed good general condition and axillary temperature of 3ยบ C. Abdominal palpation did not detect any masses or organomegaly, showing mild discomfort in the periumbilical area.
Blood analytical data are normal except leukocytosis of 13,900 cel/mcl with neutrophilia of 83 %, CRP of 51 mg/l and erythrocyte sedimentation rate of 39 mm/h.
Urine sediment showed microscopic hematuria, the rest of its parameters being normal.
The urinocultive test is negative.
An abdominal ultrasound showed a cystic lesion of 4.3x2 cm, located in the anterior wall of the abdomen, reaching up to the bladder dome, with echogenic content in its interior and walls with complicated urachal vascularization.
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With the suspected diagnosis of infected urachal cyst, antibiotic treatment with Fosfomycin was initiated, with evident clinical improvement within a few hours.
During follow-up, a control abdominal ultrasound was performed, which showed a solid and irregular mass, located above the bladder dome, 1.8x1.2 cm in size and in relation to the rest of the persistent urachus.
Likewise, urethrocystography showed no communication with the bladder and no vesicoureteral reflux was detected.
Once the diagnosis of urachal cyst was confirmed, surgical excision was scheduled.
After two weeks with antibiotic treatment infraumbilical-extraperitoneal midline laparotomy, we performed a complete exeresis of the urachus, including the uracal cyst and a vesical rod.
There were no intraoperative complications and the subsequent evolution was satisfactory.
Currently the patient is asymptomatic and the cystography performed one month after surgery the bladder has a normal morphology.
