INTRODUCTION The urachus is a remnant of a channel between the bladder and the umbilicus where urine initially drains in the foetus stduring the 1 trimester of pregnancy. thUrachus usually seals off and obliterates around the 12 week of gestation and all that is left is a small brous cord between the bladder and umbilicus called the median umbilical ligament. Diagnosis of a persistent urachus/urachal cyst remains challenging due to the rarity of this lesion and the nonspecic nature of its symptomatology. CASE REPORT A 35-yr. old male presented in outpatient department of CHA with complains of pain in lower abdomen (suprapubic region) for last 15 days and umbilical sepsis with periumbilical erythema for 8 days. No history of nausea, vomiting or change in bowel or bladder habits. Systemic examination revealed periumbilical erythema and tenderness in suprapubic region with soft abdomen. Erythema subsided with intravenous antibiotic therapy for one week. Ultrasonography of abdomen and pelvis showed heterogeneous mass of size ~4.4x2.8 cm in midline extending from anterior wall to urinary bladder. Laparotomy was performed through an infraumbilical incision, which revealed a cyst surrounded by an inammatory mass extending into the dome of the urinary bladder with two surrounding brous cords. The infected urachal cyst and brous cords were excised and sent for histopathological analysis to rule out any evidence of malignancy. Postoperative period was uneventful and patient was discharged in satisfactory condition. Histopathological analysis of the resected specimen showed chronic granulomatous inammation with no evidence of malignancy. On follow-up, patient is doing well with no episode of pain abdomen or bowel and bladder disturbances. DISCUSSION Urachus, developmentally is the upper part of the bladder, both of which arise from the ventral part of the cloaca and thallantois. Descent of bladder from 5 month of development into the foetal pelvis pulls the urachus with it resulting in formation of urachal canal. The lumen of this canal progressively obliterates during the foetal life, with eventual formation of brous tract in early adult life. Histologically, composed of 3 layers: 1) innermost layer: modied transitional epithelium similar to urothelium 2) middle layer: broconnective tissue 3) outermost layer: smooth muscle continuous with detrusor muscle Urachal anomalies occur when there is incomplete seal off of the urachal lumen results in following abnormalities. Types: - 1) PATENT URACHUS (50%): When the urachus did not seal off and there is a connection between the bladder and the umbilicus. 2) CYST (30%): When a section of the urachus did not seal off, but there is not a connection between the bladder and umbilicus. A CASE REPORT OF AN INFECTIVE URACHAL CYST IN ADULT Original Research Paper Dr. Pranjal Anil Banthia rd3 Year Resident, Department of General Surgery, B.J. Medical College, Civil Hospital, Ahmedabad. General Surgery KEYWORDS : Dr. Hitendra K Desai Assistant Professor, Department of General Surgery, B.J. Medical College, Civil Hospital, Ahmedabad. Dr. Purvesh Doshi* nd2 Year Resident, Department of General Surgery, B.J. Medical College, Civil Hospital, Ahmedabad. *Corresponding Author VOLUME-8, ISSUE-11, NOVEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra 14 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS It is rare in adults; more common in men than women. In adults, most common variety is urachal cyst, with infection being usual mode of presentation. Route of infection is haematogenous, lymphatic, direct or ascending from bladder. Commonly cultured organisms are Enterococcus faecium, Proteus spp., Streptococcus viridians and Fusobacterium spp. Our case highlights the potential complications related to congenital urachal anomalies, presenting with as umbilical sepsis with supra pubic pain. Diagnosis of an infected urachal cyst made after radiological investigations. The risk of urachal malignancy is high among adults with poor prognosis. Histologically, the innermost layer of the urachus is mainly transitional cell. Adenocarcinoma is the predominant histological type and most are mucinous. This is probably due to metaplasia arising from chronic inammation. The prognosis for urachal adenocarcinoma does not differ signicantly from non- urachal adenocarcinoma and is relatively poor, with a 5-year survival of 37% and a 10-year survival of 17%. Ultrasound scan can help to make diagnosis in 77% of patients. As in our case, ultrasound nding gave the diagnosis of urachal cyst showing collection/mass from anterior abdominal wall to urinary bladder. CT scan or MRI scan is essential in case of malignancy. Diagnosis is often made following exploratory laparotomy for an unexplained acute abdomen. The treatment of choice for urachal cyst is by complete primary excision. However, Yoo et al. in their study suggested a two- stage procedure involving initial incision and drainage followed by later excision of the urachal remnant. Complete excision is important because malignant transformation of the remnant is possible. Traditionally, open excision has been the approach of choice. However, a laparoscopic approach is also an attractive alternative in recent years. The advantage of this approach is good view and the minimal risk of incomplete excision of the urachal remnant. Funding No funding. REFERENCES 1. Hammond G, Yglesias L, Davis JE. The urachus, its anatomy and associated fascia. Anat Rec 1941; 80:271–4. 2. Nimmonrat A, Na-ChiangMai W, Muttarak M. Urachal abnormalities: Clinical and imaging features. Singapore Medical Journal 2008;49(11):930–5. 3. Risher WH, Sardi A, Bolton J. Urachal abnormalities in adults: The Ochsner experience. South Med J 1990;83(9):1036–9. 4. Yoo KH, Lee SJ, Chang SG. Treatment of infected urachal cysts. Yonsei Medical Journal 2006;47(3):423–7. 5. Begg RC. The Urachus. Its anatomy, histology and development. J Anat 1930;64(Pt 2):170–83. 6. Ashley RA, Inman BA, Routh JC, Rohlinger AL, Husmann DA, Kramer SA. Urachal anomalies: A longitudinal study of urachal remnants in children and adults. J Urol 2007;178(4 Pt 2):1615–8. 7. Grignon DJ1, Ro JY, Ayala AG, Johnson DE, Ordóñez NG. Primary adenocarcinoma of the urinary bladder: A clinicopathologic analysis of 72 cases. Cancer 1991;67(8):2165–72. 8. Yohannes P, Bruno T, Pathan M, Baltaro R. Laparoscopic radical excision of urachal sinus. Journal of Endourology 2003;17(7):475–9. 9. Groot-Wassink T, Deo H, Charfare H, Foley R. Laparoscopic excision of the urachus. Surg Endosc 2000;14(7):680–1. 10. Cutting CW, Hindley RG, Poulsen J. Laparoscopic management of complicated urachal remnants. BJU Int 2005;96(9):1417–21. VOLUME-8, ISSUE-11, NOVEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra X 15GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS