Bladder injury caused by a urachal remnant during laparoscopic ileocecal resection: A case report

Introduction: Bladder injuries that occur during laparoscopic surgery are rare but a serious complication. In particular, patients with urachal remnants have a high risk for bladder injuries during suprapubic port insertion. We report the case of a bladder injury caused by a urachal remnant during laparoscopic ileocecal resection for cecal cancer. Case presentation: A 46-year-old man diagnosed with cT2, N0, M0, stage I cecal cancer underwent laparoscopic ileocecal resection. A suprapubic port was inserted under direct vision. After ileocecal resection, a bladder injury was discovered after the removal of the suprapubic port. The suprapubic port wound was extended to reveal the bladder wall around the injury, and the injury was sutured. During surgery, preoperative computed tomography (CT) results were reviewed, and sagittal CT revealed a urachal remnant. The postoperative course was uneventful, and the patient was discharged 10 days after surgery. Discussion: Urachal remnants are rare in adults. This case emphasizes that although it is difficult to diagnose asymptomatic urachal remnants preoperatively, sagittal CT scans may aid in the diagnosis. Careful consideration of port placement and preoperative urethral catheter insertion is important to prevent bladder injuries in cases of urachal remnants. Conclusion: Sagittal CT scans are considered effective in detecting diverticulum-type urachal remnants. Port placement without the need for a suprapubic trocar should be considered in cases with urachal remnants.