The story described is about a one-and-a-half-year-old boy who is brought with occasional complaints of yellow discharge from his belly button. During a detailed examination, the doctor notices a small hole on the inner surface of the belly button. Since the child is not willing to undergo an X-ray to see how far a piece of medicated liquid can travel from the hole, the doctor opts for an ultrasound instead. The ultrasound reveals an open channel between the belly button and the bladder, known as a “patent urachus”. The doctor performs surgery to remove the channel and successfully restores the child’s health.

In the pediatric surgeon’s journal, I will explain the presence of urachus remnants.

In previous journals, I have discussed with you the formation of a connection between the umbilical cord and the intestines, bladder while the baby is in her mother’s abdomen. Normally, this connection between the bladder and the umbilical cord closes after birth and becomes a thin, fibrotic cord-like structure. However, sometimes it fails to close.

Please watch the youtube video to understand the below explaining: 

If the connection between the bladder and the umbilical opening remains completely open, meaning if there is a channel or pathway between the child’s umbilical hole and the bladder, we refer to this as an open urachus channel. This problem can sometimes present itself in newborns as a thickened umbilical cord filled with urine or in older children as occasional discharge of urine-like fluid from the umbilicus, accompanied by redness and signs of infection.

Sometimes both ends of this channel can close, meaning the bladder and umbilical opening are blocked. However, a cystic structure can develop in the middle portion. In such cases, signs of infection may appear, or if the cyst becomes large, it can cause abdominal pain or can compress the bladder, leading to problems within the abdomen.

In other instances, the umbilical end of the channel may close while the bladder end remains open. This can lead to the formation of a bladder diverticulum, which can result in urinary tract obstruction and urinary tract infections.

Lastly, there are cases where the bladder end closes while the umbilical end remains open. In such situations, an urachal sinus is formed, which can manifest in infants as a persistent umbilical polyp or granuloma

 

The exact percentage of urachus problems occurring is not known. In one study, it was found that 1% of children who were examined for various reasons over a period of 12 years had urachal issues.

As I mentioned earlier, these problems can present with symptoms such as discharge from the umbilicus, redness and infection around the umbilicus, abdominal pain, or palpable masses below or along the midline of the abdomen. In some cases, they can also be incidentally detected during routine examinations without any apparent symptoms. In adults, they can manifest as bloody or painful urination, abdominal pain, and other related symptoms.

Diagnosis often involves a simple ultrasound examination. If a hole is visible inside the umbilicus, a contrast agent can be injected into the hole and an X-ray can be taken. In cases of suspected issues, a urinary catheter can be inserted to fill the bladder and reveal other associated problems such as bladder diverticulum.

It is stated that about half of the urachal remnants removed in adults contain malignant cancer cells. However, we do not have such data concerning children. Nevertheless, considering the potential risk of infection, surgical removal is recommended. However, some surgeons may choose not to recommend surgery if a urachal remnant is incidentally detected, taking into account the risks of possible malignant disease or infection and opting for lifelong monitoring.

The extent of surgery will vary depending on the pathology, but generally speaking, I can say that it is not a major surgery that causes great concern.

We have reached the end of another session. In the next session, I will discuss what can happen when the connection between the intestines and the umbilicus remains intact.

If you want to watch the video with detailed diagrams, please click…

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May 2023,

Prof. Dr. Egemen Eroglu