PMC5120188_01
CT scan demonstrating a Foley catheter in the decompressed bladder with (a) demonstration of a urachal cyst connection from the anterior reflection of the bladder to the umbilicus with dilated small bowel loops and adjacent fat stranding and (b) a normal appearing posterior appendix off the cecum.
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Prior to incision, the CT scan was reexamined and a fluid collection with surrounding fat stranding was noted extending from the bladder to the umbilicus with a transition point at the phlegmon (Figure 1(a)). Moreover, a normal appendix was visualized (Figure 1(b)).
Intraoperative and pathology specimens showing anatomical and microscopic inflammatory findings consistent with urachal cyst as the etiology for small bowel obstruction. (a) Urachal cyst in the inferior right intraperitoneal cavity as the cause of small bowel obstruction. (b) Microscopic inflammation with severe neutrophilia.
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fig2
Upon entry into the peritoneal cavity, a 4 x 5 centimeter cystic mass was encountered inferiorly and to the right of the umbilicus which was adherent and in continuity with the bladder (Figure 2(a)). Pathology revealed fibroadipose tissue with severe and chronic inflammation consistent with urachal cystitis (Figure 2(b)).