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Urachal cysts are unusual anomalies resulting from incomplete closure of the urachus. They comprise 38 per cent of urachal abnormalities. They present commonly in childhood, and there are only 20 reported cases of urachal cysts presenting in a person over the age of 40. Only one reported case appears of urachal-colonic fistula, and this was in the setting of colonic diverticulitis. This report presents the second reported case of urachal-colonic fistula and the first case of a fistula in a patient with a normal colon. The pathophysiology and management of urachal cyst are discussed.
URACHAL ANOMALIES ARE UNUSUAL abnormalities resulting from incomplete closure of the fetal urachus. Four variations occur: congenital patent urachus (42%), urachal cyst (38%), umbilical-urachal sinus (16%), and vesicourachal diverticulum (3%).1-5 Typically, these variations present in infancy or childhood. Urachal cysts rarely present beyond early adulthood and then usually occur as an infected cyst. The literature reveals only 20 cases occurring in patients over the age of 40,4 and in only one reported case has it been associated with a colonic fistula.5 This report presents the case of a patient over the age of 40 with a urachal-sigmoid fistula in the absence of underlying colonic pathology.
Case Report