Introduction: An urachal cyst is a rare congenital anomaly in an adult female of child bearing age, being more common in males. Acute presentations can easily be mistaken for other abdominal and pelvic pathologies. We report such a case with intra-operative laparoscopic illustrations.Case presentation: A 21-year-old Caucasian female presented acutely with lower abdominal pain, fever and vomiting. The differential diagnosis included acute appendicitis. A diagnostic laparoscopy was performed which demonstrated a mass on the anterior abdominal wall. This was excised as a one-stage procedure and the specimen was later confirmed to be an urachal cyst on histological examination. The patient made good post-operative recovery and was discharged home.Conclusion: This case demonstrates an acute presentation of an infected urachal cyst. As illustrated, laparoscopic surgery allowed the diagnosis to be made easily. We support that infected urachal cysts should be treated with a one-stage excision. Introduction The urachus or median umbilical ligament is a structure that is obliterated in the early part of infancy and therefore is a rare finding in adult patients1. It is a fibrous cord that arises from the anterior aspect of the bladder wall and extends up to the umbilicus2. Urachal abnormalities are more common in men than women5. Presentation can be varied and may be asymptomatic. Infection of the urachal cyst can mimic other abdominal pathology including appendicitis, Crohn’s disease and pelvic inflammatory disease3. Infection can occur through the lymphatics, the bladder, or the blood stream2. In rare circumstances, if the cyst ruptures, it can lead to peritonitis4.We describe a case of an infected urachal remnant in a young woman of child-bearing age that mimicked acute appendicitis but was diagnosed on laparoscopy. Case Report A 21-year-old Caucasian female presented acutely with a 2-day history of lower abdominal pain and tenderness in the right iliac fossa, associated with vomiting, anorexia and fever. Clinically, she was pyrexial, tachycardic and looked flushed. On abdominal examination, she was tender suprapubically and in the right iliac fossa. Blood tests revealed a leukocytosis and an elevated C-reactive protein. A provisional diagnosis of acute appendicitis was made and the patient was prepared for a diagnostic laparoscopy. At laparoscopy a normal appendix was found. There was no evidence of pelvic inflammatory disease or cystic ovaries. A mass was seen on the anterior abdominal wall and free flow of pus was confirmed on aspiration. The structure was suspected to be a urachal cyst. The decision was made to perform a laparoscopically assisted open excision, via a transverse Pfannenstiel incision, and the cystic structure was mobilised and excised. The bladder dome was repaired in two layers. Figure 1 is a picture taken during laparoscopy of the urachal cyst and its relation to the right ovary and bladder, and figure 2 demonstrates its attachment to the urinary bladder.
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