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\begin{document}

\title{A case of retroperitoneal abscess caused by infection of urachal remnant}



\author[1]{Akira Yoneda}%
\author[1]{Taiji Hida}%
\author[1]{Hanako Tetsuo}%
\author[1]{Saeko Fukui}%
\author[1]{Shunsuke Murakami}%
\author[1]{Takayuki Miyoshi}%
\author[1]{Tatsuya  Okamoto}%
\author[1]{Amane Kitasato}%
\author[1]{Hiroaki Takeshita}%
\author[1]{Tamotsu Kuroki}%
\affil[1]{National Hospital Organisation Nagasaki Medical Center}%


\vspace{-1em}



  
  \date{June 11, 2024}


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\selectlanguage{english}
\begin{abstract}
Infection of urachal remnant may cause recurrent abscesses. In the
current case report, we describe an urachal remnant infection leading to
a retroperitoneal abscess, which is extremely rare condition. In such
cases, the recommended treatment is urachal remnant resection.%
\end{abstract}%



\sloppy


Clinical Image

\textbf{A case of retroperitoneal abscess caused by infection of urachal
remnant}

Akira Yoneda, Taiji Hida, Hanako Tetsuo, Saeko Fukui, Shunsuke Murakami,
Takayuki Miyoshi, Tatsuya Okamoto, Amane Kitasato, Hiroaki Takeshita,
and Tamotsu Kuroki

Department of Surgery, National Hospital Organization Nagasaki Medical
Center

\textbf{Corresponding author:} Akira Yoneda, Department of Surgery,
National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara,
Omura, Nagasaki 856-0835, Japan.

Tel.: +81-957-52-3121; Fax: +81-957-54-0292; Email: akira-br@infoseek.jp

Written informed consent was obtained from the patient to publish this
report in accordance with the journal's patient consent policy.



\textbf{Abstract}

Infection of urachal remnant may cause recurrent abscesses. In the
current case report, we describe an urachal remnant infection leading to
a retroperitoneal abscess, which is extremely rare condition. In such
cases, the recommended treatment is urachal remnant resection.

\textbf{Keywords:} retroperitoneal abscess, urachal remnant, ureteral
resection

\textbf{Case presentation}

Abscess formation due to infection of urachal remnants is usually
localized. A retroperitoneal abscess resulting from such infection is
quite rare. {[}1{]} {[}2{]}.

A 65-year-old man with fever and abdominal pain was admitted to our
hospital.

Upon computed tomography (CT), we observed gas and extensive abscess
formation in the preperitoneal space from the lower abdomen to the
pelvis (Fig 1A). We performed emergency laparotomy. Laparoscopic
examination of the abdominal cavity revealed no obvious perforation of
the gastrointestinal tract and no obvious abscess formation; however,
there was marked swelling of the abdominal wall centered on the midline
umbilical cord, suggesting abscess formation in the same area (Fig 1B).
Through a midline incision in the lower abdomen, the Retzius cavity was
opened and cleaned, and a drainage tube was placed. On follow-up at 4-6
months postoperatively, a recurrence of retroperitoneal abscess was
observed. The patient underwent CT-guided drainage of this new abscess.
CT contrast scan showed a slightly hyperdense cord-like structure
extending from the umbilical region to the bladder, which was assumed to
be a urachal remnant (Fig 1C). This led us to the conclusion that the
abscess must have formed in this urachal remnant, subsequently spreading
to the retroperitoneum. Hence, we decided to resect this urachal
remnant. A laparoscopic ureteral remnant resection was performed. The
median cord, i.e., the presumed urachal remnant, was detached from the
abdominal wall (Fig 1D).



\textbf{Acknowledgments}

None.

\textbf{Conflict of interest}

The authors declare that there is no conflict of interest that could be
perceived as prejudicing the impartiality of the research reported
herein.

\textbf{Author contributions}

Akira Yoneda involved in case identification, writing, review and
editing the manuscript. Taiji Hida, Hanako Tetsuo, Saeko Fukui, Shunsuke
Murakami, Takayuki Miyoshi, Tatsuya Okamoto, Amane Kitasato and Hiroaki
Takeshita involved in review, writing, and editing the manuscript.
Tamotsu Kuroki involved in supervision of the study.

\textbf{Ethical Approval}

The study is conducted ethically in accordance with the World Medical
Association Declaration of Helsinki.

\textbf{Consent}

Informed consent for publication and related images has been obtained
from the patient.

\textbf{Data availability statement}

The data that support the findings of this study are available on
request from the corresponding author. The data are not publicly due to
privacy or ethical restrictions.

\textbf{References}

1. Sato H, S Furuta, S Tsuji, H KawaseH Kitagawa, The current strategy
for urachal remnants. \emph{Pediatr Surg Int} 2015;31(6):581-587. doi:
10.1007/s00383-015-3712-1

2. Araki M, T Saika, D Araki, Y Kobayashi, S Uehara, T Watanabe\emph{,
et al.} , Laparoscopic management of complicated urachal remnants in
adults. \emph{World J Urol} 2012;30(5):647-650. doi:
10.1007/s00345-012-0829-x.

\textbf{Figure legends}

Figure 1A: CT. Gas and extensive abscess formation in the preperitoneal
space from the lower abdomen to the pelvis.

Figure 1B: Laparoscopic image. There was marked swelling of the
abdominal wall centered on the midline umbilical cord, suggesting
abscess formation in the same area.

Figure 1C: CT. A slightly hyperdense cord-like structure extending from
the umbilical region to the bladder, which was assumed to be a urachal
remnant

Figure 1D: Laparoscopic image. The median cord, i.e., the presumed
urachal remnant, was detached from the abdominal wall.

.\selectlanguage{english}
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