Umbilical Cyst

　　Urachal cysts are relatively rare. However, in clinical surgery, it is not uncommon to find a幕-shaped depression in the middle of the bladder apex or an unsealed segment of the urachus in the lower abdomen.

　　The urachal cyst is formed during fetal development, with both ends closed and a cavity formed in the middle, filled with secretions or debris of shed cells of the epithelium.

　　The cause of this disease is that during the embryonic period, when the bladder is 10-24 millimeters in size, it expands to the umbilicus. After that, the bladder descends along the anterior abdominal wall. During this descent, a thin tube remains connected to the urachus, which gradually becomes thinner, closes, and forms a fibrous cord connecting the umbilicus to the anterior bladder wall. If this tube does not completely close and there is still a cavity, it becomes a urachal fistula. If both ends are closed but the middle part is not completely sealed, there is a possibility of forming a cyst.

　　Urachal fistula is caused by congenital developmental anomalies and is rare in clinical practice. It is due to the closure of both ends of the urachus but not the middle, with the fluid secreted by the urachal epithelium forming.

　　Umbilical infection in children is the most common complication, with urachal cysts presenting as a cystic mass in the midline of the lower abdomen, not changing with body position, superficially related to the abdominal wall, with delayed healing of the wound and sometimes with redness and swelling of the umbilical ring. Small granulation surfaces can be seen in the umbilical concavity, or there may be a small amount of mucus or purulent secretions at the umbilical stump. In severe cases, symptoms of cellulitis such as redness, swelling, heat, and pain may occur. In more severe infections, there may be marked redness, swelling, and hardening around the umbilicus, with a large amount of purulent secretions. Light pressure on the umbilicus may cause pus to ooze from the umbilical concavity with an odor.

　　Urachal fistula is caused by congenital developmental anomalies and is rare in clinical practice. It is due to the closure of both ends of the urachus but not the middle, with the fluid secreted by the urachal epithelium forming. The main clinical manifestations of urachal cyst are:

　　In the midline of the lower abdomen, there is a cystic mass that does not change with body position, located superficially and closely related to the abdominal wall. Large urachal cysts are similar to intraperitoneal tumors, which can compress the intestines, causing symptoms such as abdominal pain. They can also become abscesses due to secondary infection. Both abscesses and cysts can rupture, perforating outward into the abdomen or into the bladder or into the peritoneum and pelvis.

　　Urachal fistula is a congenital developmental anomaly, and there are currently no effective preventive measures. Urachal cyst is the main cause of umbilical infections in children. If a child's umbilicus leaks fluid, one should consider this condition and seek medical treatment. Delaying the condition may lead to the spread of infection, endangering the child's life. If there is no infection, surgical excision should be performed. If there is an infection, it should be actively treated, and after the infection is controlled, surgical excision should be performed.

　　The urachal cyst is a cavity formed at both ends of the fetus, with the middle closed, filled with secretions or debris of shed cells of the epithelium. If the urachus does not close completely, symptoms may appear within a few days after birth, with urine dripping from the umbilicus. The distal part of the urachus forms a spherical nodule, part of which is covered by skin and part by the urachal epithelium, with the surrounding skin stimulated but less severe than a fecal fistula.

　　For those suspected of having an umbilical urachal cyst, an ultrasound examination is the first choice. The following characteristics are described:

　　1. A fusiform anechoic mass can be seen in the deep abdominal wall below the navel, located between the navel and the bladder.

　　2. The mass moves in the same direction as deep breathing.

　　3. When the cyst cavity is infected, it shows dense dot-like echoes, which are caused by the accumulation of pus, necrotic and dissolved tissue debris, and exudate from the cyst wall.

　　4. The inner wall of the cyst cavity is rough, and the outer wall is not clear.

　　5. The shape of the cyst changes with bladder filling or emptying.

　　6. Intracystic stones can appear as strong echoes. In addition, IVU, cystoscopy, and abdominal CT scan are not only helpful for diagnosis but also helpful for distinguishing from other abdominal lesions.

　　Patients with umbilical urachal cysts should have a regular diet, balanced diet, regular meals at regular times, and not overeat or starve.

　　Appropriate Diet

　　Diet should be light, eat more vegetables and fruits, rationally match the diet, and pay attention to adequate nutrition. Diversify the diet, eat more high-protein, high-vitamin, low-animal-fat, easily digestible foods, and fresh fruits and vegetables.

　　Dietary Taboos

　　Do not eat stale, deteriorated, or刺激性 things, eat less smoked, roasted, pickled, fried, or salty foods, and do not eat spicy, stimulating, stale, deteriorated, or greasy foods.

　　Umbilical urachal cyst is the main cause of umbilical infection in children. If the child's umbilical discharge is found, this disease should be considered, and a doctor should be consulted for treatment. Delaying the condition will cause the infection to spread, endangering the child's life.

　　Treatment Principles

　　In the treatment of this disease, if there is no infection, surgical resection should be performed. If there is already an infection, active treatment of the infection should be carried out, and after the infection is controlled, surgical resection should be performed.

　　1. Control infection using antibiotics and dressing techniques.

　　2. Surgical resection of the cyst.

　　Principles of Drug Use

　　If there is no infection in the disease, antibiotics do not need to be used before surgery, and general antibiotics can be used after surgery to prevent infection.

　　However, if urinary tract infection and umbilical urachal abscess are present, antibiotics should be used, and intravenous administration is preferred. Generally, 1-2 types of antibiotics are sufficient, and mainly rely on surgical treatment.