A Case of Vesicoumbilical Fistula with Bladder Prolapse following Rupture of Umbilical Cord Cyst

Abstract

A female neonate presenting with vesicoumbilical fistula with bladder prolapse was delivered by cesarean section at 32 weeks and 5 days of gestation owing to threatened preterm labor. Prenatal ultrasonography at 12 weeks and 4 days of gestation revealed a gourd-shaped umbilical cord cyst, but the cyst disappeared at 24 weeks and 2 days of gestation. Her ruptured bladder was prolapsed through a defect at the lower basement of the umbilical cord, which required emergent surgery. During the surgery, a vesical capacity of 8 ml/kg was preserved when the resection line of the bladder was determined, because excessive bladder resection may cause urological complications. Histopathological analysis revealed no urachus tissue, but bladder tissue was involved in the resected specimen. The voiding cystourethrogram at POD25 revealed no urinary complications, vesicourethral reflux, or lower urinary tract obstruction, and she was discharged at POD36. With the progress in fetal ultrasonography, umbilical cysts have been reported to be diagnosed as the urachal remnant or urachal cyst after birth. When the fetal umbilical cyst disappears during the prenatal period, a rupture of the umbilical cyst is suspected. At radical surgery, it is important to measure the vesical capacity to avoid urological complications after surgery.