Urachal fistula
Introduction
Introduction to urachal fistula Urethral ureteral obstruction leads to umbilical urethral fistula clinically rare, with umbilical leakage as the main feature, and local symptoms may occur when infected. Methylene blue was injected into the bladder to observe whether the leakage was blue-stained, and the contrast agent, excretory bladder urethrography or cystography could be diagnosed in the pupil. The treatment method is surgical removal of the fistula. Since some patients may have lower urinary tract obstruction, attention should be paid to the removal of obstruction. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: bacteremia
Cause
Cause of urachal fistula
Cause (30%):
The etiology of urachal fistula is not fully understood, although some people think it is related to urinary tract obstruction, but in fact, only 14% of neonates with urachal fistula found evidence of obstruction, and severe posterior urethral valve are not all at the same time. There is a urachal fistula, not to mention the urinary catheter closure before the formation of the urethra.
Prevention
Umbilical hernia prevention
The etiology of urachal fistula is not fully understood, although some people think it is related to urinary tract obstruction, but in fact, only 14% of neonates with urachal fistula found evidence of obstruction, and severe posterior urethral valve are not all at the same time. There is urachal fistula, so this disease can not be prevented, so early detection, early diagnosis and early treatment are of great significance for indirect prevention of this disease.
Complication
Urethral fistula complications Complications bacteremia
Because the umbilical part has secretions for a long time, it is easy to cause infection of the umbilicus, and there is a manifestation of redness, swelling and heat pain. Severe case infection can directly enter the umbilical vein from the umbilicus, causing bacteremia. Patients may have high fever, chills, vomiting, abdominal pain and other manifestations. Once the above symptoms occur, blood culture tests should be carried out to identify pathogens, and antibacterial treatment should be carried out according to the type of infection.
Symptom
Symptoms of urachal fistula Common symptoms Causing granulation tissue in the umbilical fossa
Almost all patients go to the umbilical hole to discharge liquid and seek medical treatment. When the abdominal pressure is increased, the degree is more obvious. The degree depends on the size of the fistula. The larger part of the umbilicus continues to have fluid outflow. When the fistula is small, the umbilicus is only wet, and 97.5% of the umbilical part is swollen. Local granulation tissue is prominent, or covered by rot, the diagnosis of urachal fistula is generally not difficult. The suspicious person inserts a thin catheter into the umbilicus to flow out of the liquid. The liquid urea nitrogen and creatinine content can be judged whether it is urine. liquid.
Examine
Umbilical hernia examination
Injecting methylene blue into the bladder through the catheter or through the urethra, it is seen that the umbilicus is outflowing or the blue urine is discharged through the urethra. If the above situation occurs, the possibility of urachal fistula should be considered. Urinary bladder urethrography can not only exclude urethral obstruction, but also the specific location of the fistula and the size of the fistula. As for cystoscopy, it is not absolutely necessary. For the need to distinguish from other malformations, cystoscopy can be performed.
Diagnosis
Diagnosis and differentiation of urachal fistula
The diagnosis of urachal fistula is generally not difficult. If a suspicious person inserts a thin catheter from the umbilicus, there is a liquid outflow. The liquid urea nitrogen and creatinine levels can be determined to determine whether it is urine.
The umbilical urethral fistula needs to be differentiated from the umbilical hernia. The latter also occurs in the umbilicus, but it is connected to the intestine. Therefore, the effluent is feces instead of urine. After intravenous injection of the stain, the effluent is not stained. The contrast agent in the yolk tube is shown to enter the intestinal lumen, generally the lower ileum.
