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Congenital Urachal Diverticulum in Dogs: A Case Report: Ojszczyk-Szczepaniak A., Miech A., Wojnowski T

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Medycyna Wet.

2010, 66 (6) 421

Opis przypadku Case report

Congenital urachal diverticulum in dogs: a case report


ANNA OJSZCZYK-SZCZEPANIAK, ANNA MIECH*, TOMASZ WOJNOWSKI**

Laboratory of Radiology and Ultrasonography, Department and Clinic of Animal Surgery,


*Department of Pathological Anatomy, Faculty of Veterinary Medicine University of Life Sciences,
Gboka 30, 20-612 Lublin
**Veterinary Surgery, Orla 4/13, 20-022 Lublin

ojszczyk-Szczepaniak A., miech A., Wojnowski T.


Congenital urachal diverticulum in dogs: a case report
Summary
This study reports the case of a 4-year-old female Mastiff dog in which a congenital urachal diverticulum
was diagnosed. The disorder was related with atypical clinical manifestations. The animal was referred for
a radiological evaluation with the clinical signs of ataxia. The owner stated that the symptoms improved after
each spontaneous micturition of a dog.
The radiological study revealed the presence of degenerative changes in the lumbosacral spine. Moreover,
an abnormal shape of the urinary bladder in the abdominal cavity was observed. The ultrasound imaging
showed a large diverticulum in the cranioventral part of bladder. The operative procedure and histopatho-
logical analyses have confirmed the presence of a urachal diverticulum. The clinical symptoms completely
abated after the surgery.
Keywords: dog, urachal diverticulum, urinary bladder

Bladder diverticula occur infrequently in domestic basis of the ultrasonographic and radiological exami-
animals. Congenital and acquired diverticula (9, 10) nation. This initial evaluation was confirmed during
currently are known. The acquired diverticula (pseudo- the surgical intervention and histological examination.
diverticulum) develop after traumatic injury to the
bladder or may be of neurogenic or iatrogenic origin Case report
(5, 10, 12). The common causes for diverticulum A female Mastiff aged 4 years was presented to the
development are such conditions like: cystitis, neopla- Laboratory of Radiology and Ultrasonography for exami-
stic tumors or urolithiasis that lead to the intravesical nation of the lumbosacral spine and abdominal cavity. The
pressure growth as a result of a lack or increased resi- medical history revealed that the dog showed signs of
stance of urine outflow (5, 10, 11). More frequently ataxia. According to the owner, the signs could not be
reported diverticula are those arising from malforma- associated with any reason and they disappeared after each
tion and anatomical defects, including, among others, micturition of the animal. The laboratory urinalysis indica-
anomalies within the urachal duct (4, 10). ted a slight amount of squamous epithelium, leukocytes and
These disorders have been addressed in only a few erythrocytes in the urine sediment (tab. 1).
scientific reports on veterinary research (5, 9). Some
of them focus on the occurrence of diverticula related Tab. 1. Analysis of dogs urine
with the urachal abnormalities. C olor straw
In the prenatal life, the urachus is continuous be-
A p p e a ra n c e clear
tween the fetal urinary bladder and the allantois. After
parturition it undergoes atrophy during the lumen U rinary specific gravity 1 .0 1 0
cicatrization at the bladder apex (4). If this process P rotein +/
is disturbed or the obliterated duct gets re-patented, pH 6 .0
a number of pathologies occur within this structure.
B lood pigment, ketones, glucose, bilirubine negative
Depending on the a urachal part involved in the patho-
logical process, the development of patent urachus, S ediment: squamous epithelial cells 0 -8
urachal ligament, sinus or urachal cyst and urachal Leukocytes 0 -4
diverticulum (3, 4, 9) can be discerned. R ed blood cells 0 -1
The paper reports a case of a dog whose initial
U rine casts negative
diagnosis of a urachal diverticulum was made on the
422 Medycyna Wet. 2010, 66 (6)

A radiographic examination was car-


ried out in the lateral right recumbency
(fig. 1). An image of the lumbosacral
spine visualized the presence of degene-
rative changes between the seventh lum-
bar and the first sacral vertebrae (cauda
equine syndrome). A view of the visceral
organs did not show any abnormalities.
The only anomaly observed in the ab-
dominal cavity appeared to be a round
shadow of 3 cm diameter; its opacity was
similar to soft tissues at the cranioven-
tral part of the moderately filled urinary
bladder. The round shadow was clearly
visible due to the adipose tissue that
separated it from the small intestine and
other abdominal organs.
Another diagnostic modality used was
the ultrasound examination. It confirmed
the evidence of an oval thin-walled,
liquid-filled structure projected cranio-
ventrally out of the urinary bladder lumen Fig. 1. The survey radiograph of the abdominal cavity. Visible round shadow at
(fig. 2). Its dimensions were 2.8 2.6 cranioventral part of the urinary bladder
cm with a clearly visible connection of
1.5 cm distance to the bladder. During the ultrasound ima- The ultrasonographic studies performed immediately
ging procedure, the transducer pressure directed towards after animal micturition had the purpose of determining
the urinary bladder caused the thin-walled structure change potential urinary retention in the bladder (fig. 3). The
its shape and size. At the ventral and dorsal wall of the reduction of the urinary bladder volume and diverticulum
bladder, in the site of the lesion communication with the to only a slight level was visualized. The actual lesion size
bladder lumen, some echogenic structures resembling an was 2.7 1.5 cm and the shape of the discovered formation
incomplete septum of the structure characteristic of a blad- was also changed.
der wall were also visualized. The urinary bladder was On the basis of the ultrasonographic and radiological
moderately filled with aechogenic urine. No deviations in evaluation an initial recognition of a gross diverticulum at
the structure or echostructure of the other visceral organs, the cranial-ventral part of urinary bladder with concomi-
including kidneys, were recorded. tant urostasis in the urinary bladder and diverticulum was

Fig. 2. Ultrasound evaluation. Noticeable gross diverticulum Fig. 3. Ultrasound image of the urinary bladder and diverti-
in communication with the urinary bladder lumen culum examination immediately after the dogs micturition
Medycyna Wet. 2010, 66 (6) 423

established. The dog was referred to the doctor who decided


to perform a surgical resection of the lesion.
The surgical procedure was conducted under general
(xylasine and ketamine iv.) anaesthesia. The dog positioned
in a dorsal recumbency had the integument incised for
a distance of 10 cm at the median line of the postumbilical
region. The urinary bladder was slightly filled and the
diverticulum was visible only after its expansion by urine
and pressure on the bladder base. It involved the bladder
apex and had a diameter of approximately 3 cm with a cen-
trally located scar after the urachus. The lesion without any
clinical signs of an active neoplastic process was excised
at the diverticulum base and closed with two series of simple
interrupted sutures using 3/0 Safil thread (polyglycolic acid).
As no postoperative inflammatory reaction was observed
within the urinary bladder, the dog was administered a single-
-dose of amoxicillin therapy (Hostamox L.A.). Fig. 4. Microscopic view of bladder diverticulum
The resected diverticulum was sent for histopathologi-
cal evaluation. Having fixed the sections in 10% neutral
phormol, they underwent the routine hematoxylin-eosin ful metabolites. Consequently, metaplasia of the uri-
(H&E) staining. nary bladder mucosa may develop and, in turn, neo-
The microscopic image revealed all the layers of the plastic lesions are formed (6). In humans a correlation
urine bladder. between the formation of a urinary bladder diverticula
The marked hypertrophy of the muscle layer was found, and development of neoplastic changes has been
visualized by the occurrence of thickened trabecula carnea observed. These have been reported to occur in appro-
running in many directions as well as a proliferation of the ximately 1-10% of all bladder diverticula and 1.5% of
fibrous connective tissue (fig. 4). The other bladder struc- all carcinomas arising in the bladder and recognized
tures did not show any pathomorphological changes. in humans (6, 11).
The pain symptoms persisted for around 2 weeks fol- Survey radiographs of the abdominal cavity prove
lowing the surgical operation of the dog. At the time of unsatisfactory for complete diagnosis, therefore posi-
acute post-operative pain, the animal showed the best tive contrast cystography or double contrast cytography
therapeutic response to diastolic drugs (Biovetalgin, NO- is required (10). Studies allow for visualization of
-SPA). Significantly, during the follow-up and at present a diverticulum as a smooth-walled structure connected
(15 months) the dog has demonstrated full clinical symp- with the urinary bladder lumen and, in the case of the
tom relief. anomalous urachus, located at the cranial-ventral part
of bladder (1, 7, 8). Radiographs need to be taken
Discussion in the lateral right and left side projections (10). This
Abnormalities within the urachal duct, including the is important because thin-walled diverticula tend to
development of a urachal diverticulum have been collapse, so frequently they can not be visualized on
rarely reported in veterinary literature. Most frequently the basis of only one projection. In the discussed case,
they are documented in cats (8). A urachal diverticula a spherical structure of diverticulum was noticeable
develops as a result of partial obliteration and closure on the survey radiograph; however, a definitive dia-
of the lower portion of the urachus at the bladder apex. gnosis could not be established on the grounds of the
In humans they account for only 3% of anomalies radiographs taken. As a result ultrasound examination
within this structure, thus constituting the rarest entity was recommended and performed. This evaluation,
in this group of disorders (2, 4, 13). though, appears to have some difficulties. The diverti-
Quite frequently, diverticula remain asymptomatic culum localization at the cranioventral part of urinary
so are usually diagnosed incidentally. Only the com- bladder causes its collapse when the patient is posi-
plications following urine retention in the bladder tioned dorsally and thus any abnormalities within the
causes occurrence of clinical signs like stranguria and urinary tract might not be detected in the examination.
dysuria (10, 11). The aforementioned complications An additional diagnostic problem proves to be the in-
include recurrent urinary tract infections, urolith for- complete filling of the bladder (10). In the present case,
mation (ammonium magnesium phosphate), develop- none of the above-mentioned difficulties occurred,
ment of vesicoureteral reflux, hydroureter and hydro- most likely due to the large size of the pathological
nephrosis (5, 9, 10). Some fistulas between the urinary change and various positioning of the dog during the
bladder and the adjacent organs may occur as a result examination, predominantly in the right lateral recum-
of the diverticulum infection (7). Chronic persistent bency and in a standing position. However, changes in
irritation of the urinary bladder mucosa due to urinary the diverticulum shape and size were visualized be-
stasis directly exposes the mucous membrane to harm- tween the successive examination stages. The diverti-
424 Medycyna Wet. 2010, 66 (6)

culum was visible as a thin-walled structure in direct Whereas the congenital anomalies are due to weak-
communication with the urinary bladder lumen. Im- ness of the bladder detrusor muscle, with no risk of
portantly, some features indicating urine retention were rupture (5).
noted in the absence of other characteristics associa- In the presented case, the canine diverticulum was
ted with cystitis or other disorders that may arise from found to consist of all urinary bladder layers and the
the retention indicated in the laboratory findings or medical report did not have any past history of dif-
imaging study. ficult micturition, which may imply the congenital
Taking into account the medical history with the origin of the disorder.
ultrasonographic image of a lesion and its characteristic
localization in the cranioventral part of the urinary blad- References
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It is usually reported in the cases of traumatic injuries Corresponding author: lek. wet. Anna ojszczyk-Szczepaniak, Gboka
or diseases characterized by difficult micturition (10). 30, 20-612 Lublin; e-mail: anna.lojszczyk@gmail.com

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