TITLE:
Laparoscopic Resection of a Urachal-Sigmoid Fistula in a Heart Transplant Patient
AUTHORS:
Bogdan Protyniak, Ryan N. Cappa, Michael Latzko, Adam M. Kopelan
KEYWORDS:
Urachal-Sigmoid Fistula, Diverticulitis, Immunosuppression
JOURNAL NAME:
Surgical Science,
Vol.6 No.2,
February
3,
2015
ABSTRACT:
Introduction: Urachal remnants are
rare in adulthood with only a few cases of urachal-sigmoid fistula reported in
the literature. We report the first case of a laparoscopic resection of a
urachal-sigmoid fistula resulting from diverticulitis in an immunosuppressed
heart transplant patient. Case Description: The patient is a 43-year-old male
who underwent an orthotopic heart transplant one month prior for dilated
cardiomyopathy. His presenting symptom was abdominal pain and imaging showed a
sigmoid-urachal fistula. A laparoscopic sigmoidectomy with resection of the
urachal cyst and drainage of pelvic abscess was performed. The cyst was found
to be contiguous and inseparable from the bladder, and therefore a small cuff
of bladder was included with the specimen followed by primary laparoscopic
cystorrhaphy. He had an uncomplicated hospital course. Discussion: Our case contained
several unique aspects that altered the ultimate care and hospital course of
the patient. Immunosuppressed patients possess multiple risk factors predictive
of poor surgical outcome—infection, bleeding, and hollow organ perforation. The
patient in this study was on multiple immunosuppressants and exhibited no
peritoneal signs despite an elevated leukocytosis and some worrisome radiologic
findings. Our decision to operate early was influenced by the aforementioned
factors and led to an uncomplicated recovery.