Un residuo del pasado con repercusión actual: quiste uracal en mujer adulta con infecciones urinarias recurrentes
Palabras clave:
uraco, quiste del uraco, infecciones urinarias, reinfección
Resumen
El quiste uracal es una anomalía congénita poco frecuente derivada del remanente embrionario del uraco, que conecta la vejiga con el ombligo. Su persistencia en la vida adulta puede predisponer a infecciones recurrentes y, en casos graves, a la ruptura y otras complicaciones, como la malignización.
Presentamos el caso de una mujer de 32 años con historia de infecciones urinarias recurrentes, tratadas de manera empírica, sin una respuesta adecuada hasta la identificación incidental de un quiste uracal durante una exploración laparoscópica por abdomen agudo. La tomografía computarizada y la ecografía iniciales no revelaron hallazgos concluyentes. El diagnóstico final se realizó mediante histopatología, confirmando el quiste uracal. El tratamiento quirúrgico resolvió los síntomas, y la paciente fue dada de alta con seguimiento infectológico.
Este caso destaca la importancia de considerar el quiste uracal en el diagnóstico diferencial de infecciones urinarias recurrentes, y la relevancia de la intervención quirúrgica en pacientes sintomáticos con el diagnóstico realizado.
Citas
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2. Scheye T, Vanneuville G, Amara B, Francannet P, Dechelotte P, Campagne D. Anatomic basis of pathology of the urachus. Surg Radiol Anat [Internet]. 1994 [cited 2024 Feb 4];16(2):135–41. Available from: https://pubmed.ncbi.nlm.nih.gov/7940076/ Subscription required
3. Das JP, Vargas HA, Lee A, Hutchinson B, O'Connor E, Kok HK, et al. The urachus revisited: multimodal imaging of benign & malignant urachal pathology. Br J Radiol [Internet]. 2020 [cited 2024 Feb 4];93(1110):20190118. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10993214/
4. Parada Villavicencio C, Adam SZ, Nikolaidis P, Yaghmai V, Miller FH. Imaging of the urachus: anomalies, complications, and mimics. Radiographics [Internet]. 2016 [cited 2024 Feb 4];36(7):2049–63. Available from: https://pubmed.ncbi.nlm.nih.gov/27831842/
5. Mesrobian HG, Zacharias A, Balcom AH, Cohen RD. Ten years of experience with isolated urachal anomalies in children. J Urol [Internet]. 1997 [cited 2024 Feb 4];158(3 Pt 2):1316–8. Available from: https://pubmed.ncbi.nlm.nih.gov/9258204/ Subscription required
6. Gleason JM, Bowlin PR, Bagli DJ, Lorenzo AJ, Hassouna T, Koyle MA, Farhat WA. A comprehensive review of pediatric urachal anomalies and predictive analysis for adult urachal adenocarcinoma. J Urol [Internet]. 2015 [cited 2024 Feb 4];193(2):632–6. Available from: https://pubmed.ncbi.nlm.nih.gov/25219697/
7. Kumar R, Harilal S, Abdelgawad MA, Ghoneim MM, Kumar A, Mathew B. Urachal carcinoma: the journey so far and the road ahead. Pathol Res Pract [Internet]. 2023 [cited 2024 Feb 4];243:154379. Available from: https://pubmed.ncbi.nlm.nih.gov/36821941/ Subscription required
8. Guerin M, Miran C, Colomba E, Cabart M, Herrmann T, Pericart S, et al. Urachal carcinoma: a large retrospective multicentric study from the French genito-urinary tumor group. Front Oncol [Internet]. 2023 [cited 2024 Feb 4];13:1110003. Available from: https://pubmed.ncbi.nlm.nih.gov/36741023/
9. Olah C, Kubik A, Mátrai P, Engh MA, Barna V, Hegyi P, et al. Estimation of the incidence of urachal cancer: a systematic review and meta-analysis of registry-based studies. Urol Oncol [Internet]. 2024 [cited 2025 Mar 4];42(7):221.e1–221.e7. Available from: https://pubmed.ncbi.nlm.nih.gov/38627107/
10. Perez D, Neeman B, Kocherov S, Jaber G, Armon Y, Zilber S, Chertin B. Current management of the urachal anomalies (UA): lessons learned from the clinical practice. Pediatr Surg Int [Internet]. 2022 [cited 2024 Feb 4];38(11):1619–23. Available from: https://pubmed.ncbi.nlm.nih.gov/35969254/ Subscription required
11. Dethlefs ChR, Abdessalam SF, Raynor SC, Perry DA, Allbery SM, Lyden ER, et al. Conservative management of urachal anomalies. J Pediatr Surg [Internet]. 2019 [cited 2024 Feb 4];54(5):1054–8. Available from: https://pubmed.ncbi.nlm.nih.gov/30867097/ Subscription required
12. Tsai IS, Lin LH, Hung SP. An infected urachal cyst presenting as acute abdominal pain in a child: a case report. Medicine (Baltimore) [Internet]. 2020 [cited 2024 Feb 4];99(5): e18884. Available from: https://pubmed.ncbi.nlm.nih.gov/32000391/
13. Buddha S, Menias ChO, Katabathina VS. Imaging of urachal anomalies. Abdom Radiol (NY) [Internet]. 2019 [cited 2024 Feb 4];44(12):3978–89. Available from: https://pubmed.ncbi.nlm.nih.gov/31478084/ Subscription required
14. Yusuf S, Wassef AC, Schlesinger A. An infected urachal cyst in a 4-year-old girl presenting with recurrent abdominal pain. J Emerg Med [Internet]. 2019 [cited 2024 Feb 4];56(4):e51–e54. Available from: https://pubmed.ncbi.nlm.nih.gov/30879848/ Subscription required
15. Lipskar AM, Glick RD, Rosen NG, Layliev J, Hong AR, Dolgin SE, Samuel Z Soffer SZ. Nonoperative management of symptomatic urachal anomalies. J Pediatr Surg [Internet]. 2010 [cited 2024 Feb 4];45(5):1016–9. Available from: https://pubmed.ncbi.nlm.nih.gov/20438945/ Subscription required
16. Ohgaki M, Higuchi A, Chou H, Takashina K, Kawakami S, Fujita Y, et al. Acute peritonitis caused by intraperitoneal rupture of an infected urachal cyst: report of a case. Surg Today [Internet]. 2003 [cited 2024 Feb 4];33(1):75–7. Available from: https://pubmed.ncbi.nlm.nih.gov/12560915/ Subscription required
17. Orbatu D, Alaygut D. Evaluation and management of urachal remnants in children. Pediatr Int [Internet]. 2020 [cited 2024 Feb 4];62(10):1158–61. Available from: https://pubmed.ncbi.nlm.nih.gov/32347613/ Subscription required
18. Fromer DL, Cheng WY, Gao Ch, Mahendran M, Hilts A, Duh MS, et al. Likelihood of antimicrobial resistance in urinary E. coli isolates among US female patients with recurrent versus non-recurrent uUTI. Urology [Internet]. 2024 [cited 2025 Mar 4];190:1–10. Available from: https://pubmed.ncbi.nlm.nih.gov/38467284/
19. Malcolm W, Fletcher E, Kavanagh K, Deshpande A, Wiuff C, Marwick Ch, Bennie M. Risk factors for resistance and MDR in community urine isolates: population-level analysis using the NHS scotland infection intelligence platform. J Antimicrob Chemother [Internet]. 2018 [cited 2024 Feb 4];73(1):223–30. Available from: https://pubmed.ncbi.nlm.nih.gov/29040608/
20. Yu JS, Kim KW, Lee HJ, Lee YJ, Yoon CS, Kim MJ. Urachal remnant diseases: spectrum of CT and US findings. Radiographics [Internet]. 2001 [cited 2024 Feb 4];21(2):451–61. Available from: https://pubmed.ncbi.nlm.nih.gov/11259707/
21. Liu Z, Yu X, Hu J, Li F, Wang S. Umbilicus-sparing laparoscopic versus open approach for treating symptomatic urachal remnants in adults. Medicine (Baltimore) [Internet]. 2018 [cited 2024 Feb 4];97(26):e11043. Available from: https://pubmed.ncbi.nlm.nih.gov/29952943/
22. Araki M, Saika T, Araki D, Kobayashi Y, Uehara S, Watanabe T, et al. Laparoscopic management of complicated urachal remnants in adults. World J Urol [Internet]. 2012 [cited 2024 Feb 4];30(5):647–50. Available from: https://pubmed.ncbi.nlm.nih.gov/22290478/ Subscription required
2. Scheye T, Vanneuville G, Amara B, Francannet P, Dechelotte P, Campagne D. Anatomic basis of pathology of the urachus. Surg Radiol Anat [Internet]. 1994 [cited 2024 Feb 4];16(2):135–41. Available from: https://pubmed.ncbi.nlm.nih.gov/7940076/ Subscription required
3. Das JP, Vargas HA, Lee A, Hutchinson B, O'Connor E, Kok HK, et al. The urachus revisited: multimodal imaging of benign & malignant urachal pathology. Br J Radiol [Internet]. 2020 [cited 2024 Feb 4];93(1110):20190118. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10993214/
4. Parada Villavicencio C, Adam SZ, Nikolaidis P, Yaghmai V, Miller FH. Imaging of the urachus: anomalies, complications, and mimics. Radiographics [Internet]. 2016 [cited 2024 Feb 4];36(7):2049–63. Available from: https://pubmed.ncbi.nlm.nih.gov/27831842/
5. Mesrobian HG, Zacharias A, Balcom AH, Cohen RD. Ten years of experience with isolated urachal anomalies in children. J Urol [Internet]. 1997 [cited 2024 Feb 4];158(3 Pt 2):1316–8. Available from: https://pubmed.ncbi.nlm.nih.gov/9258204/ Subscription required
6. Gleason JM, Bowlin PR, Bagli DJ, Lorenzo AJ, Hassouna T, Koyle MA, Farhat WA. A comprehensive review of pediatric urachal anomalies and predictive analysis for adult urachal adenocarcinoma. J Urol [Internet]. 2015 [cited 2024 Feb 4];193(2):632–6. Available from: https://pubmed.ncbi.nlm.nih.gov/25219697/
7. Kumar R, Harilal S, Abdelgawad MA, Ghoneim MM, Kumar A, Mathew B. Urachal carcinoma: the journey so far and the road ahead. Pathol Res Pract [Internet]. 2023 [cited 2024 Feb 4];243:154379. Available from: https://pubmed.ncbi.nlm.nih.gov/36821941/ Subscription required
8. Guerin M, Miran C, Colomba E, Cabart M, Herrmann T, Pericart S, et al. Urachal carcinoma: a large retrospective multicentric study from the French genito-urinary tumor group. Front Oncol [Internet]. 2023 [cited 2024 Feb 4];13:1110003. Available from: https://pubmed.ncbi.nlm.nih.gov/36741023/
9. Olah C, Kubik A, Mátrai P, Engh MA, Barna V, Hegyi P, et al. Estimation of the incidence of urachal cancer: a systematic review and meta-analysis of registry-based studies. Urol Oncol [Internet]. 2024 [cited 2025 Mar 4];42(7):221.e1–221.e7. Available from: https://pubmed.ncbi.nlm.nih.gov/38627107/
10. Perez D, Neeman B, Kocherov S, Jaber G, Armon Y, Zilber S, Chertin B. Current management of the urachal anomalies (UA): lessons learned from the clinical practice. Pediatr Surg Int [Internet]. 2022 [cited 2024 Feb 4];38(11):1619–23. Available from: https://pubmed.ncbi.nlm.nih.gov/35969254/ Subscription required
11. Dethlefs ChR, Abdessalam SF, Raynor SC, Perry DA, Allbery SM, Lyden ER, et al. Conservative management of urachal anomalies. J Pediatr Surg [Internet]. 2019 [cited 2024 Feb 4];54(5):1054–8. Available from: https://pubmed.ncbi.nlm.nih.gov/30867097/ Subscription required
12. Tsai IS, Lin LH, Hung SP. An infected urachal cyst presenting as acute abdominal pain in a child: a case report. Medicine (Baltimore) [Internet]. 2020 [cited 2024 Feb 4];99(5): e18884. Available from: https://pubmed.ncbi.nlm.nih.gov/32000391/
13. Buddha S, Menias ChO, Katabathina VS. Imaging of urachal anomalies. Abdom Radiol (NY) [Internet]. 2019 [cited 2024 Feb 4];44(12):3978–89. Available from: https://pubmed.ncbi.nlm.nih.gov/31478084/ Subscription required
14. Yusuf S, Wassef AC, Schlesinger A. An infected urachal cyst in a 4-year-old girl presenting with recurrent abdominal pain. J Emerg Med [Internet]. 2019 [cited 2024 Feb 4];56(4):e51–e54. Available from: https://pubmed.ncbi.nlm.nih.gov/30879848/ Subscription required
15. Lipskar AM, Glick RD, Rosen NG, Layliev J, Hong AR, Dolgin SE, Samuel Z Soffer SZ. Nonoperative management of symptomatic urachal anomalies. J Pediatr Surg [Internet]. 2010 [cited 2024 Feb 4];45(5):1016–9. Available from: https://pubmed.ncbi.nlm.nih.gov/20438945/ Subscription required
16. Ohgaki M, Higuchi A, Chou H, Takashina K, Kawakami S, Fujita Y, et al. Acute peritonitis caused by intraperitoneal rupture of an infected urachal cyst: report of a case. Surg Today [Internet]. 2003 [cited 2024 Feb 4];33(1):75–7. Available from: https://pubmed.ncbi.nlm.nih.gov/12560915/ Subscription required
17. Orbatu D, Alaygut D. Evaluation and management of urachal remnants in children. Pediatr Int [Internet]. 2020 [cited 2024 Feb 4];62(10):1158–61. Available from: https://pubmed.ncbi.nlm.nih.gov/32347613/ Subscription required
18. Fromer DL, Cheng WY, Gao Ch, Mahendran M, Hilts A, Duh MS, et al. Likelihood of antimicrobial resistance in urinary E. coli isolates among US female patients with recurrent versus non-recurrent uUTI. Urology [Internet]. 2024 [cited 2025 Mar 4];190:1–10. Available from: https://pubmed.ncbi.nlm.nih.gov/38467284/
19. Malcolm W, Fletcher E, Kavanagh K, Deshpande A, Wiuff C, Marwick Ch, Bennie M. Risk factors for resistance and MDR in community urine isolates: population-level analysis using the NHS scotland infection intelligence platform. J Antimicrob Chemother [Internet]. 2018 [cited 2024 Feb 4];73(1):223–30. Available from: https://pubmed.ncbi.nlm.nih.gov/29040608/
20. Yu JS, Kim KW, Lee HJ, Lee YJ, Yoon CS, Kim MJ. Urachal remnant diseases: spectrum of CT and US findings. Radiographics [Internet]. 2001 [cited 2024 Feb 4];21(2):451–61. Available from: https://pubmed.ncbi.nlm.nih.gov/11259707/
21. Liu Z, Yu X, Hu J, Li F, Wang S. Umbilicus-sparing laparoscopic versus open approach for treating symptomatic urachal remnants in adults. Medicine (Baltimore) [Internet]. 2018 [cited 2024 Feb 4];97(26):e11043. Available from: https://pubmed.ncbi.nlm.nih.gov/29952943/
22. Araki M, Saika T, Araki D, Kobayashi Y, Uehara S, Watanabe T, et al. Laparoscopic management of complicated urachal remnants in adults. World J Urol [Internet]. 2012 [cited 2024 Feb 4];30(5):647–50. Available from: https://pubmed.ncbi.nlm.nih.gov/22290478/ Subscription required
