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CC BY 4.0 · Journal of Coloproctology 2025; 45(04): s00451813740
DOI: 10.1055/s-0045-1813740
Case Report

Case Report of Urachal Remnant Causing Extensive Fistulization between the Sigmoid Colon and Bilateral Adnexae with Cyst-Cutaneous Fistula

Authors

  • Yaeji Park

    1   Section of Colon and Rectal Surgery, Department of Surgery, The University of Chicago, Chicago, IL, United States

  • Carla Harmath

    2   Department of Radiology, The University of Chicago, Chicago, IL, United States

  • Gladell P. Paner

    3   Department of Pathology, The University of Chicago, Chicago, IL, United States

  • Hillary McLaren

    4   Department of Obstetrics & Gynecology, The University of Chicago, Chicago, IL, United States

  • Obianuju Sandra Madueke-Laveaux

    4   Department of Obstetrics & Gynecology, The University of Chicago, Chicago, IL, United States

  • Sarah Faris

    5   Department of Urology, The University of Chicago, Chicago, IL, United States

  • Kinga S. Olortegui

    1   Section of Colon and Rectal Surgery, Department of Surgery, The University of Chicago, Chicago, IL, United States
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Abstract

Case report

We present the case of a 20-year-old female with purulent umbilical drainage.

Materials and Methods

Workup initially included a contrast-enhanced computed tomography scan of the abdomen and pelvis, which revealed large bilateral tubo-ovarian abscesses communicating with a tract to the umbilicus, with concern regarding involvement of the sigmoid colon. A drain was placed, and cultures from the abscess demonstrated growth of α-hemolytic streptococci and Trueperella (Arcanobacterium) bernardiae.

Results

Colonoscopy was normal. During preparation for colonoscopy, the patient noted passage of high volume of clear fluid from the umbilicus. A fistulogram through the umbilical opening revealed a complex fistulous network involving the umbilicus, bilateral adnexa and rectosigmoid, with concern for small bowel involvement. Magnetic resonance enterography was unremarkable for bowel inflammation, but the study suggested the possibility of an underlying urachal remnant. Diagnostic laparoscopy was performed, which excluded presence of any small bowel involvement, and demonstrated dense adhesions of the omentum and left adnexa to the abdominal wall. Ultimately, the patient underwent a multi-disciplinary robotic-assisted urachal remnant excision, with en-bloc left oophorectomy and sigmoidectomy.

Conclusion

Urachal and omphalomesenteric remnants outside of the pediatric population are rare. To the best of our knowledge, this is the first report of such complication of a urachal remnant, with a complex fistula involving the rectosigmoid colon, adnexa and bladder. Here, we present the diagnostic and operative approach.

Keywords

urachal remnant - sigmoid - bladder - fistula

Authors' Contributions




Publication History

Received: 16 February 2025

Accepted: 11 August 2025

Article published online:
29 December 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Yaeji Park, Carla Harmath, Gladell P. Paner, Hillary McLaren, Obianuju Sandra Madueke-Laveaux, Sarah Faris, Kinga S. Olortegui. Case Report of Urachal Remnant Causing Extensive Fistulization between the Sigmoid Colon and Bilateral Adnexae with Cyst-Cutaneous Fistula. Journal of Coloproctology 2025; 45: s00451813740.
DOI: 10.1055/s-0045-1813740