Urachal Remnants in Patients Presenting to the Emergency Department with Abdominal Pain

Background: Rare causes of abdominal pain include abnormalities of the urachus, including patent urachus and urachal cyst with or without infection. However, reviews discussing etiology of abdominal pain, even in children, may completely omit mention of urachal remnants.

Objectives: Determine the incidence of symptomatic urachal remnants in patients presenting to the emergency department (ED), including common presenting findings and method of diagnosis.

Methods: A retrospective chart review was performed of all patients presenting to the ED with abdominal pain who were diagnosed with urachal remnants, including patent urachus or urachal cyst or abscess over a period of 11 years and 7 months in one hospital.

Results: There were a total of 833,317 ED visits over the time period of the chart review, with 76,954 patients or 9.2% presenting with a complaint of abdominal pain. Twenty-four patients were identified, or 0.03% of those presenting with abdominal pain. Ages ranged from 16 days to 59 years. Among those 18 years or older, there was a male-to-female ratio of 1:1 of 14 patients. Thirteen patients (54.2%) initially presented with drainage from the umbilicus.

Conclusions: Although rare, symptomatic disorders of urachal remnants may present at any age. These disorders should be kept in mind by the emergency physician among the broad list of differential diagnoses accounting for abdominal pain. Urachal cyst and abscess may present with or without drainage from the umbilicus. Drainage from the umbilicus is highly suggestive, but not pathognomonic, of a urachal anomaly, and patients should be imaged to make a definite diagnosis and assist in the management plan.