An 11-year-old girl with Type 1 Diabetes was successfully treated for a rare congenital condition after what was initially suspected to be an abdominal tumour was diagnosed as an infected urachal cyst, a condition caused by a persistent connection between the urinary bladder and the umbilicus present since birth.
The child had been experiencing recurrent urinary tract infections and persistent discomfort for six months. An ultrasound scan performed at an outside centre suggested the possibility of a heteroechoic suspicious mass lesion arising from the superior wall of the urinary bladder with increased vascularity, causing significant anxiety and emotional distress for the family. Following the case and its details, doctors determined that the lesion was not cancerous. The patient was admitted and a urinary drainage catheter was inserted. Repeat ultrasonography showed emphysematous cystitis with an infected urachal cyst. A contrast-enhanced CT scan further confirmed the diagnosis.
Understanding Urachal Cysts
Doctors explained that urachal cysts are rare congenital anomalies caused by the persistence of a remnant connection between the bladder and umbilicus. Although usually detected in infancy because of symptoms such as umbilical discharge or omphalitis, some cases may remain asymptomatic for years and become apparent only after infection. The condition is uncommon, with an incidence estimated at one to 2.5 cases per 100,000 live births, and occurs more frequently in males than females.
Challenges in Diabetic Patients
In patients with Type 1 Diabetes mellitus, recurrent infections can significantly increase morbidity. Any infectious episode carries a higher risk of progression to severe sepsis, which may lead to complications such as multi-organ dysfunction syndrome. Sepsis can also adversely affect glycaemic control, resulting in marked fluctuations in blood glucose levels and making diabetes management more challenging. Recurrent infections and poor glycaemic control may further accelerate diabetes-related complications. Therefore, definitive surgical management of the urachal cyst was considered essential to eliminate the source of recurrent infection and reduce future morbidity.
Robotic Surgery Approach
The infection was initially treated medically to reduce inflammation and stabilise the patient. Once the infection was controlled, the surgical team proceeded with robotic-assisted surgery to excise the urachal cyst completely, repair and close the bladder connection, and preserve normal urinary function.
Dr Ashwini Khanolkar, Lead Consultant, Paediatric and Robotic Surgery at Apollo Hospitals Navi Mumbai, stated: "The diagnostic challenge in this case was that the lesion was initially suspected to be a tumour. However, further investigations confirmed that it was an infected urachal cyst, a rare congenital anomaly. Since the child was also living with Type 1 Diabetes, recurrent infections required careful management. Once the infection was controlled, we proceeded with surgery to remove the cyst and repair the bladder connection."
Dr Khanolkar added: "In this patient with Type 1 Diabetes and a urachal cyst, a robotic approach was chosen to achieve complete excision of the urachal remnant with excellent visualisation and precision while minimising wound-related complications, postoperative pain and recovery time. These advantages are particularly important in diabetic patients, who have an increased risk of infections and impaired wound healing."
Successful Outcome
The surgery was successful. The child resumed a full diet and insulin regimen soon after surgery. The urinary catheter was removed on postoperative day 14, and she returned to her routine activities within two weeks. Three months after surgery, she remains free from recurrent infections and her diabetes is well controlled.
This case highlights the importance of accurate diagnosis in paediatric surgical conditions, particularly when congenital anomalies remain silent for years before presenting with complications. It also demonstrates the role of robotic surgery in enabling precise, minimally invasive treatment in children.
Doctors emphasised that parents should seek timely medical attention if children experience recurrent urinary tract infections, persistent abdominal discomfort or ongoing urinary symptoms, as these may occasionally indicate an underlying congenital condition requiring specialist evaluation and treatment.
