title: A colo-urachal-cutaneous fistula in an 88-year-old male.
abstract: BACKGROUND
  Urachus anomalies are remnants of the urachus, an embryonic connection between the fetal bladder and umbilicus. These anomalies usually remain asymptomatic but can cause symptoms in case of infection. An extremely rare complication of symptomatic urachal remnants is fistulizing to adjacant viscera. We describe the first case of diverticulitis associated sigmoid-urachal-cutaneous fistula.
  
  
  METHODS
  An 88-year-old male visited the outpatient clinic with intermittent bleeding and gassy discharge from his umbilicus. Examination showed a normal looking umbilicus with a small fissure at the bottom in which a 10 cm probe could be inserted. Laparotomy revealed a fistula extending from the umbilicus to a pus filled cyst superior to the bladder. A second fistula between the cyst and a mid-sigmoid diverticulum was identified. The involved sigmoid segment was resected. Pathological examination demonstrated no malignancy.
  
  
  CONCLUSIONS
  Urachal remnants are extremely rare in adults. They typically present with abdominal pain or palpable masses. Additional imaging can aid the diagnostic process.
  
  
  CONCLUSIONS
  Due to the risk of recurrence and malignant transformation complete surgical excision of urachal anomalies is the treatment of choice. This can be done in a 1-step or 2-step procedure.
authors.affiliation: University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Peters
authors.forename: Marjan J P
authors.initials: MJ
authors.lastname: Kruijer
authors.forename: Hans
authors.initials: H
authors.lastname: Wiese
authors.forename: Paul C M
authors.initials: PC
authors.lastname: Verbeek