Clinical considerations, management and treatment of fever of unknown origin caused by urachal cyst: a case report

Introduction: Urachal cysts are rare congenital anomalies that often prompt referral to the paediatric generalsurgeon because of their associated complications such as infection, abdominal pain and the young age atpresentation. In this report we describe a rare case of fever of unknown origin caused by an urachal cyst which wassuccessfully treated with incision and drainage only. Since the first description of urachal anomalies by Cabriolus in1550, few cases have been reported and, until now, only one case of infected urachal cyst presenting as fever ofunknown origin has been described in the literature. Moreover, the spontaneous resolution of an urachal cystwithout excision is extremely rare.Case presentation: We report our experience in the management and treatment of an infected urachal cyst thatoccurred in a 12-year-old Caucasian girl who presented to our Department of Paediatric Surgery with a 30-dayhistory of evening fever. The urachal cyst was treated only with incision and drainage through a minimally invasivelaparoscopic approach.Conclusions: The incision and drainage of an infected urachal cyst is a simple and safe procedure. It assures acomplete recovery and avoids potential surgical complications related to the total excision of the urachal cyst. Thisreport may provide important clues regarding the management of this rare anomaly and we emphasise theimportance for paediatricians, who should consider the possibility that a fever of unknown origin can be caused byan urachal cyst, and for surgeons and urologists, because it suggests that conservative treatment of this rareanomaly should be considered when possible.