Urachal Remnant: Symptoms, Causes, Treatment

What are the symptoms of an urachal remnant?

Symptoms of a urachal remnant depend on the type of remnant (urachal cyst, sinus, or diverticulum) and whether complications like infection occur. Common symptoms include:

• Abdominal Pain: Discomfort or pain in the lower abdomen, especially around the belly button.
• Fluid Discharge: Persistent or intermittent drainage of clear, cloudy, or bloody fluid from the umbilicus (belly button).
• Swelling: A palpable mass or swelling near the umbilicus due to a urachal cyst.
• Redness and Tenderness: Inflammation and tenderness around the belly button, often indicating infection.
• Urinary Symptoms: In rare cases, a connection between the bladder and the belly button can cause urine to leak from the umbilicus.
• Fever and Signs of Infection: Infected urachal remnants can cause fever, increased pain, and signs of systemic infection.

If an infection or other complication develops, symptoms often become more pronounced and require medical attention.

What are the causes of an urachal remnant?

Urachal remnants occur when the urachus, a tube-like structure present during fetal development, fails to close and disappear completely after birth. Normally, the urachus connects the bladder to the umbilicus (belly button) and helps drain urine from the fetus into the amniotic fluid. By birth, this structure typically closes and becomes a fibrous cord. However, when it doesn’t fully close, it leaves behind remnants that can cause issues later in life.

There are different types of urachal remnants, and the causes are related to incomplete closure at different points along the urachus:

• Urachal Cyst: Occurs when a portion of the urachus remains open, forming a fluid-filled cyst in the midsection of the urachus.
• Patent Urachus: Results when the entire urachus remains open, creating a direct connection between the bladder and the umbilicus.
• Urachal Sinus: Develops when the urachus remains open at the umbilical end, causing discharge from the belly button.
• Vesicourachal Diverticulum: Forms when the urachus remains open at the bladder end, leading to a pouch-like structure.

The exact reasons why the urachus fails to close in some individuals are not well understood, but it is considered a congenital anomaly that is present from birth.

What is the treatment for an urachal remnant?

Treatment for urachal remnants depends on the type and severity of the condition, as well as the presence of any associated complications like infection or malignancy. The following are common approaches to treating urachal remnants:

• Observation: In some cases, if the urachal remnant is not causing symptoms and there is no sign of infection or malignancy, careful monitoring may be recommended.
• Antibiotics: If the urachal remnant is infected, antibiotics are typically prescribed to treat the infection. This is often the first step before considering surgery.
• Surgical Removal: The definitive treatment for urachal remnants is surgical removal (urachal excision). This procedure is usually recommended because remnants can become infected or have a small risk of developing into cancer (urachal carcinoma). The surgery involves removing the urachal remnant, and in some cases, part of the bladder may be removed as well.
• Drainage: If an abscess or cyst has formed due to the urachal remnant, drainage of the fluid may be necessary in addition to surgical removal.

Early treatment is important, particularly if there are signs of infection or any complications. Surgery is typically curative, and the recurrence of issues after removal is rare.