Uracal Cyst post Laparoscopic Cholecystectomy?

[bear1113]

Hi Dr Watters, you have helped us before and we are asking your opinion again, thank you in advance! My 21 year old daughter had a lap chole 8/14/12. If you possibly could remember, she had had a Nissen 11/11, a pyloroplasy 6/12 and then had a hyerkinetic GB with an EF of 94%. You agreed with a chole and you were right. After the chole she did well with resolution of the GB symptoms and pain, yet she had alot of umbilical pain. This was ths 1st surgery the umbilicus was used. Immed post op for 2 days, she had a little difficulty urinating, no big deal. Still lots of umbilical pain and also leaking fluid, yellow brown color, sm amts that crusted until cleaned and then appeared again. Surgeon thought poss. an uracal cyst was present. Fluid finally stopped this week, however severe pain in the umbilical area is still there. Taking percocet/vicodin to keep it tolerable. MRI with and w/o contrast was normal.  CBCD,CMP,UA,PT/PTT, ESR all completely normal. Abd US done today, awaiting results. What is your take on this? Have you seen these cysts in your practice? She still occas. c/o difficulty urinating. The cyst idea makes sense but why doesn't it appear on MRI? Does she need another surgery to explore and remove a cyst if present? She is a college student, working  a part time job and trying to endure this huge amoun of pain. Any suggestions? Any advice is appreciated.I know something must done to help her. Her surgeon is leaning toward laparoscopic exploration and removal of the cyst if present. He did say that he has not done this procedure previously, but we trust him. Thank you for your help.

[Christopher R Watters, MD]

A urachal cyst would be a reportable complication of a laparoscopic cholecystectomy. A rare patient can have a patent urachal remnant which is a duct like tube connecting the belly button to the bladder. Vertually all of these folk's moms will give the story of having problems betting their belly buttons to heal after birth and describe a "wet" umbilicus that may have persisted for several weeks.

With this said, it would be much more common to have a seroma or hematoma of the wound that would drain through the incision. I am assuming that the imaging studies did not show any evidence of an intra-abdominal fluid collection or bile leak. Another possibility wound be the suture closing the fascia getting infected. If there were to be an incisional hernia there could be a piece of incarcerated fat which dies, liquifies, and drains yellow brown stuff.

These are the first things that come to mind potentially explaining what you describe.

[Christopher R Watters, MD]

If it needs to be explored I would do it locally as an open procedure.

[bear1113]

Thank you so much for your reply. Interestingly, She had a big "outie" belly button for the first 8 years or so of her life and then it just became normal looking. Always thought she had a little umbilical hernia but it never was. The drainage just stopped 4 days ago, but the pain is terrble still. The MRI showed nothing and we don't know about the US yet as it was done yesterday. Wound areas do not look infected at all and the WBC is normal with a normal diff. . I will mention your thoughts  to our surgeon. Thank you again for your input. If the US is normal, and the pain remains severe, would you explore the umbilical area? Would you suggest it be done laparoscopically?