Urachal abnormalities: clinical and imaging features.
(18/31)
INTRODUCTION: The clinical manifestation of urachal abnormalities may mimic many intraabdominal or pelvic diseases. We present clinical, imaging and pathological findings of a spectrum of complicated urachal abnormalities and determine whether imaging can be used to differentiate tumour from infection. METHODS: From January 1993 to December 2006, seven patients with surgically-proven complicated urachal abnormalities had their clinical, imaging and pathological features reviewed. RESULTS: There were three men and four women, aged 12-73 years. Four patients had infected urachal remnants and three had urachal carcinoma. The main clinical findings in infected urachal remnants were dysuria, abdominal pain and mass. The patients of urachal carcinoma presented with abdominal mass and haematuria. Computed tomography (CT) was performed in all cases, and ultrasonography (US) was performed in four cases. CT in all cases showed a mass located extraperitoneally in the midline just beneath the rectus abdominis muscle and extending from the umbilicus to the dome of the urinary bladder. There were one well-defined cystic mass and six ill-defined solid masses. US showed one cystic mass and three echogenic masses. Cystography was performed in one patient and it showed indentation to the dome of the urinary bladder with mucosal irregularity. The cystic mass and one ill-defined solid mass were pathologically-proven to be xanthogranulomatous inflammation. The other five solid masses were found to be adenocarcinoma in three and chronic non-specific inflammation in two cases. CONCLUSION: Preoperative diagnosis of urachal abnormalities may be suggested by clinical presentation and imaging features. However, it is difficult to differentiate tumour from infection based on imaging features alone. (+info)
Laparoscopic partial cystectomy for urachal and bladder cancer.
(19/31)
Minimally conjoined omphalopagi: emphasis on embryogenesis and possibility of emergency separation.
(20/31)
Minimally conjoined omphalopagus twins (MCOTs) has been recognized in the last decade as a special subgroup in which omphalopagus twins have union of peritoneal cavities through anterior lower abdominal wall defect with union of distal small intestine and patent urachal structures and associating anorectal malformation. A careful review of the current literature revealed that MCOTs have usually been separated in emergency situations within the first hours of life due to ruptured omphalocele, gastroschisis, stillbirth of one of the twins, intestinal obstruction, or requirement of enterostomy for cloacal anomaly. Pediatric surgeons should be familiar with MCOTs and ready for emergency separation with thorough knowledge of the anatomical relationships of the connecting structures and the embryologic basis for this anomaly. We present a new set of MCOTs separated in emergency conditions with a review of the relevant English literature. We give special emphasis to the common surgical characteristics and a brief discussion on the embryogenesis of this rare condition. (+info)
Endometrial stromal sarcoma presenting as prevesical mass mimicking urachal tumor.
(21/31)
Mucinous cystadenocarcinoma of the urachus associated with pseudomyxoma peritonei with emphasis on MR findings.
(22/31)
Urachal mucinous cystadenocarcinoma associated with pseudomyxoma peritonei is extremely rare; only 11 cases are reported. We describe the characteristic imaging findings of this disorder and correlate imaging features by computed tomography, magnetic resonance imaging, and ultrasonography with operative findings and histopathologic specimens. (+info)
CT urography of a vesicourachal diverticulum containing calculi.
(23/31)
Robotic assisted laparoscopic partial cystectomy and urachal resection for urachal adenocarcinoma.
(24/31)
INTRODUCTION AND OBJECTIVE: Standard treatment for urachal adenocarcinomas is open partial cystectomy and urachal resection; however, minimally invasive surgical approaches including laparoscopic and recently described robotic assisted laparoscopic partial cystectomy and urachal resection is feasible with potential less morbidity. A case of robotic assisted partial cystectomy and urachal resection for urachal adenocarcinoma is presented. Few articles in the literature have being published describing this technique and to the best of our knowledge, this is the largest and potentially most complex case approached in such a manner. METHODS: A 55 years old African American male presented with hematuria and mucosuria, cystoscopy demonstrated a tumor involving the dome of the bladder. Transurethral biopsy confirmed a urachal adenocarcinoma. Further studies revealed a negative metastatic evaluation. Preoperative abdominal/pelvic CT imaging revealed an enhancing mass extending from the inferior level of the umbilicus to the dome of the bladder. A total of 6 laparoscopic ports were used. The robotic assisted laparoscopic dissection was started at the level of the umbilicus, dissecting lateral to the right and left medial umbilical ligaments up until the dome of the bladder. A simultaneous cystoscopy with transillumination to define the bladder boundaries of this mass, with robotic assisted laparoscopic opening of the bladder, with the entire mass (including bladder component) excised and sent for frozen pathology for margin evaluation. After specimen extraction, the bladder was closed in two layers. Total surgery time was 300 minutes and intra-operative blood loss was 150cc. RESULTS: Final pathology reported a pT2N0Mx adenocarcinoma with negative margins and negative pelvic lymph nodes. Patient was started on clear liquids on postoperative day 2 and on regular diet on postoperative day 3. He was discharged on postoperative day 4. A cystogram perfomed on postoperative day 7 revealed a good bladder capacity (350 cc) and no leakage was identified. CONCLUSIONS: Robotic assisted partial cystectomy and urachal resection for urachal adenocarcinoma of the bladder is feasible even in challenging cases. This surgical approach is less morbid in terms of postoperative pain and cosmesis when compared to the open standard approach. The postoperative recovery is faster; however, application of oncological principles and comfort with laparoscopic and robotic surgery is needed prior to attempting such challenging cases. [Video - Available at: www.brazjurol.com.br/videos/september_october_2009/Spiess_609]. (+info)