eP655 - Case Report of Urachal Remnant Causing Extensive Fistulization Between the Sigmoid Colon and Bilateral Adenexae

Monday, June 3, 2024

1:51 PM – 1:56 PM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Yaeji Park, MD

General Surgery Resident
The University of Chicago
Chicago, IL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

CH

Carla Harmath, MD

Associate professor
The University of Chicago
Chicago, Illinois, United States

Disclosure information not submitted.
GP

Gladell Paner, MD

Professor of Pathology
The University of Chicago
Chicago, Illinois, United States

Disclosure information not submitted.
HM

Hillary McLaren, MD

Assistant Professor
University of Chicago
Chicago, Illinois, United States

Disclosure information not submitted.
OM

Obianuju Sandra Madueke-Laveaux, MD MPH

Associate Professor
University of Chicago
Chicago, Illinois, United States

Disclosure information not submitted.
SF

Sarah Faris, MD

Associate professor
University of chicago
Chicago, Illinois, United States

Disclosure information not submitted.

Senior Author(s)

Kinga S. Olortegui, MD, MS, FACS

Assistant Professor
UChicago Medicine
Chicago, Illinois, United States

Disclosure information not submitted.

Purpose/Background: The urachus typically obliterates by the 5th gestational month, leaving behind the median umbilical ligament. Failure of complete obliteration results in urachal remnants, such as urachal sinus, cyst and diverticula, which can become complicated by infection, fistulization, and neoplasm.Methods/Interventions: We present the case of a 20-year-old female with purulent umbilical drainage. Workup initially included a contrast-enhanced computed tomography scan of the abdomen and pelvis, which revealed large bilateral tubo-ovarian abscesses communicating with a tract to the umbilicus, with concern for involvement of the sigmoid colon. A drain was placed and cultures from the abscess demonstrated growth of α hemolytic streptococci and Trueperella (Arcanobacterium) bernardiae. Colonoscopy was normal. During preparation for colonoscopy, the patient noted passage of high volume of clear fluid from the umbilicus. A fistulogram through the umbilical opening revealed a complex fistulous network involving the umbilicus, bilateral adnexa and rectosigmoid, with concern for small bowel involvement. Magnetic resonance enterography was unremarkable for bowel inflammation, but the study suggested the possibility of an underlying urachal remnant. Diagnostic laparoscopy was performed, which excluded presence of any small bowel involvement, and demonstrated dense adhesions of the omentum and left adnexa to the abdominal wall.Results/Outcomes: Ultimately, the patient underwent a multi-disciplinary robotic-assisted urachal remnant excision, with en-bloc left oophorectomy and sigmoidectomy.Conclusion/

Discussion: Urachal and omphalomesenteric remnants outside of the pediatric population are rare. To the best of our knowledge, this is the first report of such complication of a urachal remnant, with a complex fistula involving the rectosigmoid colon, adnexa and bladder. Here, we present the diagnostic and operative approach.