A 6-year-old child recently underwent a laparoscopic appendectomy, came for a follow-up abdominal ultrasound due to sludge in the gallbladder that was detected earlier.
On ultrasound, the gallbladder is without features, pronounced mesadenitis is visualized, and in the projection of the postoperative area, an additional tubular hypoechoic structure with a hyperechoic center is visualized extending from the anterior abdominal wall near the navel to the small pelvis, without blood flow on the CDI, up to 2 mm in diameter, a small amount of free fluid (differential diagnosis: fistula / infected medial umbilical ligament, etc.).
An urgent consultation with a surgeon is recommended.
Quotes:
"The medial umbilical folds are bilateral raised ridges of parietal peritoneum in the deep aspect of the anterior abdominal wall formed by the underlying medial umbilical ligaments running from the pelvis to the umbilicus. The medial umbilical ligaments are anatomical remnants of the obliterated foetal umbilical arteries.
...
The medial umbilical folds are variably seen on CT depending on the density of the ligament and the amount of perivesical and intraperitoneal fat. These folds can be displaced laterally by a large amount of ascites."
"After the descent of bladder into the pelvis, the apical part narrows to form epithelialized fibromuscular remnant, the median umbilical ligament or the urachus. It lies in the extraperitoneal space between the fascia transversalis and parietal peritoneum along with the medial umbilical ligaments (formed from obliterated umbilical arteries). Usually, it is located in the midline. Occasionally, it may merge with the medial ligaments and may be deviated towards right or left of midline."
"Treatment of urachus anomalies requires removing the urachus throughout its entire length including each medial umbilical ligament as well as the associated peritoneum."
"Patients were treated according to the following protocol: transumbilical access with one 10 mm port using the laparoscope with working channel. The appendix was mobilized and delivered through the umbilical port and tied extracorporeally and removed."
