Indian Pediatr 2012;49: 418
Infected Urachal Cyst - An Uncommon Cause for
Incessant Cry in Newborns
Rose Mary Lawrence and G Chandrasekhar
Department of Pediatrics, Cosmopolitan Hospitals (P)
Ltd, Pattom, Trivandrum 695 004, Kerala.
A 33 day old baby presented with episodes of incessant cry
of 13 days duration, along with drawing up of knees to chest
while micturating; intermittent episodes of vomiting,
decreased feeding and mild abdominal distension, but no
constipation. Two days before presenting to us the mother
noticed a swelling in the umbilicus, with increasing
periumbilical redness, which ruptured draining pus and blood
via the umbilicus, following which the incessant cry
subsided. On examination, there was periumbilical redness,
umbilical discharge of pus and blood, local rise of
temperature and periumbilical induration per abdomen, but no
other signs. Ultrasound of abdomen revealed infected urachal
cyst. We managed the child conservatively with intravenous
antibiotics. On the 3rd post admission day, he developed
incessant cry again, along with bilious vomiting,
constipation, abdominal distension and decreased bowel
sounds (but no fever/ guarding/ rigidity). X-ray
showed multiple fluid levels consistent with paralytic ileus/
subacute intestinal obstruction. Oral feeds were stopped and
IV fluids were administered along with gastric
decompression. Laparotomy was planned in the event of
non-improvement. However, the child improved in 24 hours,
feeds were restarted after 48 hours and the baby was
discharged after 1 week, to undergo complete excision at a
In neonates, patent urachus presenting as
umbilical discharge is usually seen rather than infected
urachal cysts, which have a higher age of presentation .
Complications like intestinal obstruction are even rarer
. An urachal cyst usually presents when infected as lower
abdominal pain, fever, voiding symptoms, a palpable mass and
evidence of urinary infection. If left untreated it may
drain into the bladder or through umbilicus. The urachus
lies in an extraperitoneal fascial plane, hence an urachal
remnant is unlikely to cause an intra-abdominal pathology,
particularly intestinal obstruction. However this is seen in
neglected infections [2,3]. Ultrasound can be diagnostic in
80 to as much as >90% of cases, where diagnosis is doubtful,
a CT scan/ MRI is diagnostic [1,4]. Management is
controversial with one group advocating a 2 stage procedure
- incision and drainage followed by delayed resection 
and another group arguing that the former was developed in
the pre-antibiotic era; and that the use of appropriate
antibiotics followed by complete excision as a primary
procedure is both possible and safe [1, 5].
Acknowledgment: Dr CV Ram Mohan,
Consultant Pediatric Surgeon, Cosmopolitan Hospitals,
Trivandrum for managing the baby and giving valuable input
in writing the manuscript.
1. Yiee JH, Garcia N, Baker LA, Barber R,
Snodgrass WT, Wilcox DT. A diagnostic algorithm for urachal
anomalies. J Pediatr Urol. 2007;3:500-4.
2. Vaziri K, Ponsky TA, White JC, Orkin
BA. Urachal remnant small bowel obstruction: report of two
adult cases. Southern Medical Journal. 2005;98:825-6.
3. Frimberger DC, Kropp BP. Bladder
anomalies in children. In: Kavoussi LR, Novick
AC, Partin AW, Peters CA, editors. Campbell – Walsh
Urology, 10th ed. Philadelphia: Saunders; 2012. p. 3381-4.
4. McCollum M, MacNeily A, Blair G.
Surgical implications of urachal remnants: presentation and
management. J Pediatr Surg. 2003;38:798-803.
5. Newman BM, Karp MP, Jewett TC, Cooney DR. Advances in
the management of infected urachal cysts. J Pediatr Surg.