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Cullen TS. Embryology, anatomy, and diseases of the umbilicus together with diseases of the urachus. (1916) W. B. Saunders Company, Philadelphia And London.

Umbilicus (1916): 1 Umbilical Region Embryology | 2 Umbilical Region Anatomy | 3 Umbilical New-born Infections | 4 Umbilical Hemorrhage | 5 Umbilicus Granuloma | 6 Omphalomesenteric Duct Remnants | 7 Umbilicus Abnormalities | 8 Meckel's Diverticulum | 9 Intestinal Cysts | 10 Patent Omphalomesenteric Duct 1 | 11 Patent Omphalomesenteric Duct 2 | 12 Bowel Prolapsus at Patent Omphalomesenteric Duct | 13 Abdominal Wall Cysts by Omphalomesenteric Duct Remnants | 14 Omphalomesenteric Vessels Persistence | 15 Umbilical Inflammatory Changes | 16 Subumbilical Space Abscess | 17 Umbilicus Paget's Disease | 18 Umbilicus Infections | 19 Umbilicus Abnormalities 2 | 20 Umbilicus Fecal Fistula | 21 Umbilicus Round Worms | 22 Umbilicus Foreign Substance Escape | 23 Umbilical Tumors | 24 Umbilicus Adenomyoma | 25 Umbilicus Carcinoma | 26 Umbilicus Sarcoma | 27 Umbilical Hernia | 28 The Urachus | 29 Congenital Patent Urachus | 30 Urachus Remnants | 31 Urachal Remnants Producing Tumors | 32 Large Urachal Cysts | 33 Anterior Abdominal Wall Abscesses | 34 Urachal Cavities | 35 Umbilicus Acquired Urinary Fistula | 36 Urachal Concretions and Urinary Calculi | 37 Urachus Malignant Changes | 38 Urachus Bleeding into the Bladder | 39 Patent Urachus Tuberculosis | Figures
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Pages where the terms "Historic Textbook" and "Historic Embryology" appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms and interpretations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)

Chapter XXX. Remnants of the Urachus

Historic sketch.

Observations of Luschka.

Observations of Wutz.

Remnants of the urachus noted in various animals.

In the chapter on Embryology (p. 16) we have seen that the urachus develops primarily from the yolk-sac and that it passes from the bladder to the umbilicus. We have also learned that, although in the majority of embryos it finally forms a fibrous cord, it nevertheless shows an inherent tendency to remain patent at certain points and that the patent areas are recognized as spindle-like dilatations occurring here and there in the otherwise impervious cord.

Mery, in 1700, described two twin female fetuses. There was only one placenta, but each fetus had its cord. In each the umbilicus formed a kind of cushion elevated from one-quarter to one-third of an inch from the surface of the abdomen. In the center of each umbilicus was a hole. The colon ended at the edge of the umbilicus and formed an anus for the fetus. The fundus of the bladder was also open, forming a trough which terminated at the umbilicus.

On page 45 of his book on " Einige Krankheiten der Nieren und Harnblase," published in Berlin in 1800, Walter briefly describes the case shown in Fig. 222. He said very little is known about remnants of the urachus. He further said that Noreen, a

Swede, in a Gottingen dissertation (1749), mentioned the subject under the title "De mutatione luminum in vasis hominis nascentis, in specie de uracho.'" Noreen was probably the first person to write somewhat fully concerning dilatation of the urachus. He believed that the urachus remained open only during childhood; that after birth the canal closed and was transformed into a solid cord.



Fig. 222. — A Pabtially Patent Urachus. (After F. A. Walter.) A, the right ureter; B, the left ureter; C, represents the position of the longitudinal muscle-fibers, which have been dissected back; F, F, indicate the transverse muscle-fibers ; G, the tough submucosal H, H, bay-like dilatations of the urachus; /, indicates the prostate ; K, the nearest portion of the urethra. The specimen was from a boy twelve years of age.



Civiale. in 1823, saw a cadaver from which the intestine had been lifted out, but the pelvic organs were intact. The bladder made a prominent termination above, by a cylindric prolongation which had been cut across several lines above the bladder proper. The opening permitted the introduction of a finger into the bladder and corresponded exactly with the insertion of the urachus. It was smooth, roundish, and surrounded by a sort of muscle.

For many years a controversy went on as to the permeability of the urachus after birth. C. Simon, in his thesis published in 1843, says that Harvey, Noreen, Haller, and others had noted, in children born before the normal time, a cavity in the urachus extending more or less in the direction of the umbilicus. Into this it was possible to introduce a bristle or to inject mercury. These dilatations were, however, confined to children born prematurely.

Simon refers to a case observed by Albinus. The patient was a young man. The urachus was hollow and opened into the bladder. Albinus held that it was by no means rare to find the urachus in a permeable condition in adults.

According to Simon, Verdries, Beudt, and Haller had reported examples of the same character, and Haller in the cadaver of an adult found the urachus permeable and was able to introduce a bristle into it.

Simon mentions cases reported by Littre and Civiale, and refers to a case recorded by Boehmer in his thesis, "Deuracho humano." Boehmer's patient was a man aged forty, who died of an "inflammation in the chest." At autopsy, when water was injected into the bladder, the urachus swelled up and became prominent.

Probably the most important article that we possess is that of Luschka, published in 1862.

Luschka deals with the so-called obliterated urachus or median suspensory ligament of the bladder in adults under normal conditions. He says there is no doubt that in embryonic life the urachus remains patent as far as the umbilicus, and that it communicates with the bladder. He says that the views vary widely concerning its relationship, when the body is fully developed, and that the differences mainly have to do with the question whether in the adult this cord is hollow or solid. He says that the majority of writers agree that it is solid.

Luschka refers to the observations of Walter. This author thought that, as a rule, there was a persistence of the patent urachus and that the canal was frequently filled with a reddish fluid. On the other hand Noreen (De mutatione luminum in vasis, etc.. in specie de uracho, 1749) held the opposite view, although in one instance in an adult he was able to pass a bristle for two inches into the urachus. The views of Portal (Memoires de Paris, 1769) and Meckel (Handbuch der menschlichen Anatomic Bd. iv, S. 474) coincided with those of Noreen.

Luschka says that from the top of the bladder there pass a number of bundles of the deep detrusor muscle of the bladder. These extend upward for a certain distance (Fig. 223). The muscle gradually loses itself in a thick, pale yellow tissue which consists chiefly of elastic fibers and which really is the tendon of the smooth muscle bundle. Luschka says that, as a rule, this bundle can readily be followed in its course upward, and that it gradually diminishes in thickness and ends in the umbilical scar. Sometimes remnants of this tissue of the cord pass upward to the round ligament of the liver. More frequently, however, the median vesical ligament does not reach the umbilicus, but, beginning at a point some 5 or 6 cm. above the summit of the bladder, terminates in a number of tendon-like threads, which, usually unsymmetrically, unite with the left and right vesical ligaments, or may merge into one another, forming a kind of network. If one carefully splits the longitudinal axis of the urachus from the summit of the bladder, he will in some" cases be able to see an extension of the bladder mucosa upward as a tubular projection reaching a distance of 2 mm., and a pin-point opening may be found existing between the urachus and the bladder. Usually, however, only a small depression is noted at the summit of the bladder, and very frequently even this may be lacking, so that in the examination of the free surface of the bladder mucosa no trace of the original communication between the urachus and the bladder is visible. In these cases the beginning portion of the urachus has been obliterated. Such a complete closure of the canal, however, says Luschka, is usually noted only for a short distance. The urachus soon shows the cavity again for a length of from 5 to 7 cm., or sometimes more. The urachus, however, becomes thinner and thinner, and, as a rule, varies from 0.5 to 1 mm. in breadth. Luschka says that in the adult the cavit} T of the urachus in the median vesical ligament has a manifold tortuous course with numerous large and small round bays running off from it, giving it a nodular appearance, and occasionally a configuration suggestive of the acinous type of glands (Fig. 224) . These dilatations sometimes involve the entire circumference of the tube, but more often are lateral. In such cases they may have a broad base or be more or less pedunculated. Luschka says that he has time and again noted that some of these dilatations have grown as pipe-like branches in the length of the duct. Some of the dilatations in the course of time are nipped off, and as a result of further growth develop into cysts (Fig. 225).

The early stage of cyst formation occurring from metamorphosis of the urachus is produced very frequently as a result of the urachus remaining open only at isolated points. The cysts may vary in size. As

a rule, they are so small that they are recognized only when studied between coverglasses. They may, however, be as large as millet-seeds or reach the size of a pea. They may be isolated, but are sometimes present in large numbers, and more or less closely packed together, so that they present tumors resembling bunches of grapes.

Luschka says that he has not had any individual experience with cysts of the urachus, and knows of no observations by others, but he has not the slightest doubt that large cystic tumors of the anterior abdominal wall needing surgical interference develop and that these tumors have originated from the urachus.

He suggests that, if one wishes to study the cavity formation of the interior of



Fig. 223.— A Patext Urachus. (After H. Luschka.) (Natural size; from a man fifty years old.) The outer side of the upper end of the bladder mucosa (a) has been freed from the muscle (6) , and this has been turned outward. The muscular portion (c) and the tendinous portion (d) of the median vesical ligament have been dissected free and turned back. In this way the urachus has been exposed and here and there shows marked nodular dilatations (/, /, /).



The fluid is usually


the median vesical ligament, it is necessary to cut it out in sections, treat it with

acetic acid, and make firm pressure between glass plates. The structures can then be gradually dissected out. He then goes on to describe the ground membrane, the layer of fibers, and finally the epithelium of the urachus. In speaking of the epithelium he says that where the canal in the adult is well preserved, one can scrape away the thick layer, which is similar to the so-called transitional epithelium noted in the bladder, ureters, renal pyramids, and the pelves of the kidneys. All possible forms of these cells can be noted. Some are round, others polygonal, some are branched, and some resemble cylindric epithelium.

The contents of the urachus vary, pale yellow, thin, and translucent. It may, however, be cloudy, brown, or reddish in color. It contains a large number of cells of the type above described. There are also numerous fat-globules and not infrequently corpora amylacea. In the dilatations and in the isolated cysts the contents are frequently sticky and dirty brown. Scattered throughout the fluid are bodies which have a marked resemblance to prostatic concretions.

Veiel, a pupil of Luschka, published a thesis on the urachus in 1862. He gave a very extensive review of the literature, and referred to the patent urachus in the calf and pig. He also reported (Case 3) an observation on a man twenty-four

years of age. The urachus was 4.1 cm. long, tortuous, and

formed pearl-like dilatations. These dilatations were partly

central, partly eccentric, varied from 1 to 2 mm. in breadth,

and contained a 3 r ellowish, cloudy fluid. The largest was

situated just above the bladder. When the urachus was

placed between glass plates, the fluid could be forced from

one dilatation into the next.

Hoffmann, in 1870, when considering the pathologic

changes in the urinary tract, referred to the early work of

Walter. He says that Walter sought to prove that the

urachus under normal conditions in both sexes remained as

an open canal into which one could introduce a fine sound

and pass it to the bladder. This view was not accepted, and most of the later anatomists concluded that the urachus in the grown person was completely obliterated.

Hoffmann refers to the work of Luschka, in which it was demonstrated that in most


Fig. 224. — A Portion- of a Urachcs Seven Times Enlarged, with Numerous Large and Small Dilatations. From a man twentyseven years old. (After H. Luschka.)


Fig. 225. — Portion of a Urachus Ten Times Enlarged. (After H. Luschka.)

This here and there shows a tortuous course as indicated by a. At certain points (6, b) are dilatations. One of these dilatations (c) has already become completely nipped off, forming a cyst.


REMNANTS OF THE URACHUS. 519

of the cases the urachus is patent for a certain distance, even if it does not always communicate with the bladder. He also drew attention to the fact that Luschka agreed with Walter in holding that the urachus is lined with mucosa. With Luschka's statement that the caliber of the urachus is not uniform but tortuous, and that it has numerous large and small bays running out from it and giving rise to a nodular appearance, reminding one somewhat of an acinous gland, Hoffmann in general agreed.

Gruget, in 1872, published a very interesting thesis on urinary umbilical fistula? due to persistence of the urachus. He examined in all 82 bodies, and only twice did he find the urachus permeable.

Case 1 . — A human embryo, two and a half months old, was received by Dr. Gueniot. It weighed 20 grams. The distance from the pubes to the umbilicus was 7 mm. A portion of the abdominal wall was gelatinous. The walls of the bladder were transparent, and the bladder contained a few drops of a colorless liquid. When the bladder was opened a fine probe could be carried into the urachus, which was patent. In this case the urachus was open from the bladder to the umbilicus, and was continued as a pervious canal out into the cord for at least 3 cm.

[This is occasionally noted in a human embryo at this age — 7.5 cm.]

C a s e 2 was that of a female fetus born living at the end of the fifth month and dying twenty minutes after birth. This case also came under Dr. Gueniot's observation. The urachus was obliterated in its inferior or vesical portion, but open in its upper portion and also out into the cord, where it again became obliterated, forming a filament. Gruget, from his studies, came to the conclusion that persistence of the urachus is very rare. His article is very carefully written.

Nicaise assures us that a hollow urachus is not rare. He says that Haller demonstrated this condition in the cadaver of an adult, and that he had seen the urachus large enough to have a silk thread passed through it. He adds that Harvey, Moreau, Verdries, and Beudt had described examples of the persistence of the urachus.

Tillmanns says that Meckel, in 1809, described a cystic dilatation of the urachus. Next to the fundamental work of Luschka is that of Wutz, published in 1883. Wutz said that Peu, in his book on Obstetrics, in 1694, speaks of a tumor the size of a pigeon's egg situated at the umbilicus in a child two hours old. When this tumor was opened, urine escaped.

Wutz refers to the early literature on the urachus, mentioning the names of Blasius (1674), Littre (1701), Peyer (1741), Albinus (1754), Boehmer (1764), Portal (1769), Walter (1775), Meckel (1820), and finally reviews the findings of Luschka.

Wutz (p. 390) gives a description of his own work, and says that his observations are based on the examination of 74 bodies of various ages, including males and females.

He found that the distance from the top of the bladder to the lower margin of the umbilicus was as follows :

In the young and new-born 3.1 cm.

In persons from seventeen to twenty-five years 16.5 cm.

" " " twenty-five to seventy years 18.7 cm.

He says that at the top of the bladder the median vesical ligament has a thickness of from 2 to 2.5 mm. He then takes up the consideration of the urachus, and draws


520


THE UMBILICUS AND ITS DISEASES.




attention to the fact that Suchannek, in his investigations, left the urachus in hydrochloric acid for two days. As a result, the musculature and the connective tissue were then so soft that they could easily be removed.

Wutz, after using a 1 per cent solution of sodium chlorid. hardened the specimen in alcohol and then stained it with Grenadier's carmin, picrocarmin, or hematoxylin. The specimen was then passed through oil of cloves and mounted in Canada balsam. In this way it was possible to obtain a beautiful low-power picture and at the same time study the specimens under the higher power. Wutz says that after careful division of the rather tough capsule the transparent urachus is reached (Fig. 226). His examination showed that the commencing portion of the epithelial tube is frequently embedded in the musculature of the vertex of the bladder for a distance of 0.5 to 1 cm. He says that within the thickness of the bladder-wall the urachus often runs at an angle (Fig. 227) . On examination of the inner surface of the bladder at the point where the urachus begins, in the majority of cases there is a funnel-like depression, and at the point of the funnel a fine opening. ,

Fifty-one (69 per cent) of Wutz's cases presented an opening of such ."■

a character, into which a bristle could be passed for 0.3 to 0.5 mm. In 32 of these cases this could be carried upward for a distance of from 2 to 6 mm., while in 19 it penetrated from 1.1 to 4.8 cm. In 2 cases out of 74 (2.7 per cent) the surface of the mucosa was smooth and indicated no trace of a previous communication between the urachus and bladder. In the remaining 21 cases there was a very perceptible groove at the entrance of the urachal canal. In these cases it was. however, impossible to pass a sound upward, although it could be passed from above downward for a certain distance. In several of the cases in the first group, in which the sound could be passed from the bladder, a certain degree of obstruction was noted at the entrance of the canal. In other cases Wutz gathered the impression that the urachal opening was guarded by a valve-like structure

apparently supplied by a transverse fold. He says that, under normal conditions, the passage of urine through the urachus does not occur, notwithstanding the existing communication. In cases of marked dilatation of the bladder due to prostatic


B

Fig. 226. — Cysts of the Urachus Arranged Like a String of Pearls, from Case 17. (After J. B. Wutz's Plate xii, Fig. C.)

The cysts are near to the bladder. There are three of uniform size, with two smaller ones between them. In the upper portion of the urachus are several small, spindleshaped dilatations. V is the bladder. B is a bristle passing up into the urachus.


.Ear


y


■-


Fig. 227. — Spindle-shaped Dilatations of the Urachus. (After J. B. Wutz, Plate xi, Fig. E.) Case 22.

V is the bladder; Eur, the urachus. Near the bladder there is a small dilatation, then a spindle-shaped dilatation, and a little farther up the largest spindleshaped cyst.


REMNANTS OF THE URACHUS. 521

hypertrophy the dilatation of the canal was never noticed by him, and in the newborn the passage of a bristle was only occasionally possible.

Wutz measured microscopically the epithelial tube and found that the average length in the new-born was about 1.6 cm., in adults, 6.7 cm., and in one case it was 7.7 cm. He says that the greatest diameter (1.5 to 2 mm.) of the urachal tube is at or near the bladder. In the region of the umbilicus it had become smaller, being 0.5 mm. The cells forming the lining of the urachus were large, oval, and showed large nuclei. Some were long and had tails, and there were many branching, flat epithelial cells. As a rule, there were three layers of epithelium. In the upper portion there were sometimes two layers, but finally only one layer. The transverse section of the urachus was usually not round, but flattened or elliptic, and not infrequently wavy. The outer longitudinal layer of muscle Wutz found to be constant, and in all cases it extended beyond the epithelial tube above.

Wutz's summary is as follows:

1. The epithelial tube of the median vesical ligament in most cases in its lower portion can be sounded from the bladder. In other words, a probe can be passed into it from the bladder.

2. At the entrance of the urachus there is a transverse fold which makes the entrance of the sound more difficult and hinders the passage of fluid into the urachus. [This obstruction has of late years been known as Wutz's valve. — T. S. C]

3. Toward the upper end of the epithelial tube the diameter of the urachus diminishes in both its muscular and epithelial portions.

4. v The musculature under all conditions extends farther upward than the epithelial tube.

5. The beginning of the tendinous character of the median vesical ligament corresponds somewhat constantly in children to one-half, and in adults to onethird, of the distance between the umbilicus and the summit of the bladder.

Monocl, in 1899, published an interesting thesis of over 200 pages on Urinary Umbilical Fistulse Due to Persistence of the Urachus. In the historic portion of his publication he refers to the observations of Meckel, Cuvier, Pokels, Velpeau, and Robin. Monod says that he does not consider the persistence of the urachus a malformation as rare as was believed by Gueniot and his pupil Gruget, but agrees with Forgue and Morer and Trogneux that this malformation is not very frequent without being exceptional.

Meriel, in 1901, gave a very good resume of the literature, and Vaughan, in 1905, presented an interesting paper on the subject before the American Surgical Association.

Binnie, in 1906, published a paper on the development of the urachus and gave the results of Mr. Clendening's investigations. Sixteen cadavers and 7 fetuses were examined, with the following results :

1. In seven adults and six fetuses the bladder showed a distinct diverticulum from 1 to 2 cm. deep, at the point where the urachus is usually attached.

2. In one adult there was a slight projection instead of a diverticulum.

3. In eight adults and one fetus the dome of the bladder was smooth.

4. In none of the cases did Clendening find lacunae lined with epithelium in the urachus.

5. The average adult urachus was 12 cm. long and 1.5 [mm.] wide.

6. The urachus was usually adherent to the abdominal wall, but in one patient


522 THE UMBILICUS AND ITS DISEASES.

(a diabetic with frequent retention of urine) it was not close to the parietes, but lay between loops of the small intestine.

7. In all cases the urachus was well supplied with vessels.

From this review of the literature it is evident that the urachus in a certain number of cases remains patent throughout. Hence under such circumstances, as soon as the cord comes away a few days after birth, a urinary fistula exists at the umbilicus.

In other cases portions of the urachus may remain open. The vesical end of the urachus may be connected with the bladder, but more frequently small, cyst-like dilatations are found in the course of the obliterated urachal cord. These may later dilate, giving rise to urachal cysts. In some instances they become infected, and an abscess develops in the anterior abdominal wall, between the recti muscles and the peritoneum of the anterior wall of the abdomen. In those patients in whom remnants of the urachus exist, any interference with the easy passage of urine from the urethra is liable to be followed by a reopening of the urachus, with an escape of urine from the umbilicus. Such a condition may be due to a vesical calculus plugging the inner urethral orifice, to a urethral stricture or to blocking by an enlarged prostate. In quite a number of cases cystitis with its consequent vesical tenesmus has been followed by infection of the urachus and the development of a urinary umbilical fistula.

In the succeeding chapters I shall consider in detail the literature on abnormalities due to remnants of the urachus.


LITERATURE CONSULTED ON REMNANTS OF THE URACHUS.

(See also the literature of the following chapters.)

Binnie, J. F.: Development of the Urachus. Jour. Amer. Med. Assoc, 1906, ii, 109.

Civiale, J.: Traite de l'affection calculeuse, Paris, 1838, 258.

Gruget, L.: Des fistules urinaires ombilicales qui se produisent par l'ouraque reste ou redevenu

permeable. These de Paris, 1872, No. 422. Hoffmann, C. E. E.: Zur pathologisch-anatomischen Veranderung des Harnstrangs. Arch.

der Heilkunde, 1870, xi, 373. Luschka, H.: Ueber den Bau des menschlichen Harnstranges. Arch. f. path. Anat. u. Physiol.

u. f. klin. Medizin, 1862, xxiii, 1. Meriel: Les derives pathologiques de l'ouraque. Gaz. des hopitaux, Paris, 1901, lxxiv, 181. Mery: Hist. Acad, roy de sc. (de Paris), Amsterdam, 1700, 53. Monod, J. : Des fistules urinaires ombilicales dues a la persistance de l'ouraque. These de Paris,

1899, No. 62. Nicaise: Ombilic. Diet, encyclopedique des sci. medicales, Paris, 1881, 2. ser., xv, 140. Simon, C.: Quels sont les phenomenes et le traitement des fistules urinaires ombilicales. These

de Paris, 1843, No. 80. Tillmanns, H.: Ueber angeborenen Prolapsus von Magenschleimhaut durch den Nabelring

(Ectopia ventriculi) und iiber sonstige Geschwulste und Fisteln des Nabels. Deutsche

Zeitschr. f. Chir., 1882-83, xviii, 161. Vaughan, G. T.: Patent Urachus. Review of the Cases Reported. Operation on a Case Complicated with Stones in the Kidneys. A Note on Tumors and Cysts of the Urachus. Trans.

Amer. Surg. Assoc, 1905, xxiii, 273. Veiel, E.: Die Metamorphose des Urachus. Diss., Tubingen, 1862. Walter, F. A.: Einige Krankheiten der Nieren und Harnblase, Berlin, 1800. Walters, F. R.: Umbilical Pocket. Brit. Med. Jour., 1893, i, 173. Wutz, J. B.: Ueber Urachus und Urachuscysten. Virchows Arch., 1883, xcii, 387.


REMNANTS OF THE URACHUS. 523

REMNANTS OF THE URACHUS NOTED IN VARIOUS ANIMALS.

I have made no attempt to cover the literature on this subject, but while studying the urachal remains noted in the human being, I have from time to time met with references to partial or complete urachal remains noted in animals.

There seems to be little doubt that urachal remains are more commonly found in the horse than in any other domestic animal. Gurlt, in 1832, in speaking of the horse, said: "It sometimes happens that after birth the bladder with the urachus separates from the umbilicus and closes up, but a vesical portion of the urachus does not disappear, but gradually develops into an open chamber as large as the bladder itself. In these cases we have, as it were, two bladders, one sitting on the top of the other, and the two communicating through a large channel." Gurlt observed this condition in a grown horse.

O'Brien, writing in 1879, quotes Cheaureau: "In a fetal horse the bladder occupies the abdominal cavity as far as the umbilical opening, the anterior extremity forming a veritable neck. At birth this anterior neck separates from the urachus and is transformed into a cul-de-sac which is gradually withdrawn into the pelvis." O'Brien, while dissecting a young colt dead of osteitis, found that the bladder extended by a funnel-shaped canal to the umbilicus.

Finch, in 1903, reported a case of pervious urachus in a colt. The colt was ten days old and had colicky pains, as was evidenced by his uneasiness. The umbilicus was much enlarged and wet, this condition being evidently due to the presence of a pervious urachus. The colt apparently had pain over the loins. The urine was clear.

Purgatives and soothing applications were employed, but the colt died in a few days. The autopsy showed that a portion of the large bowel was inflamed. The umbilical cord was thickened and contained a small amount of thick, creamy pus. The walls of the bladder were thickened and inflamed. Nothing is stated in the protocol about the urachus.

Salvisberg, in 1902, related his experience with urachal fistulse in the horse, and outlined his method of handling them. He says that when the cord is torn off too close to the body in colts, the urachus remains open, and part of the urine escapes from the umbilicus. The urachus in colts has grown fast to the umbilical ring; consequently the closure of the ring is not so easy. If the cord of every colt were properly tied, a urinary fistula at the umbilicus would be very rare.

Salvisberg says that every spring he operates on several colts with urachal fistulse. It is no art to tie the cord 3 or 4 cm. from the abdomen.

From three to fourteen days after the birth of the colt the farmer reports the fistula. The urine drops from the umbilical opening, or during urination a certain amount escapes from the umbilicus.

Where a stump is present, the surrounding skin shows little change, the urine being carried off, as it were, through a pipe. Usually the opening is on the skin level or in a small groove. It is then surrounded by a zone of granulation tissue. The hair is wet and stuck together. An area around the umbilicus is swollen, and has scattered over it many ulcers ; or it is occupied by one large ulcer from which a purulent foul discharge comes.

Salvisberg used silver nitrate, copper sulphate, etc., but some of the colts died of pyemia or polyarthritis. The use of a purse-string suture proved of no value.


524 THE UMBILICUS AND ITS DISEASES.

Dissecting out the urachus from the umbilicus and tying was fatal, as the peritoneum has to be opened.

Salvisberg finally decides upon the following procedure: The umbilical region is shaved and disinfected and injections of salt solution are made into the parts in the immediate vicinity. These should produce small elevations, the size of hazelnuts, all around the opening; two or three rows are made. The surface is then covered with an iodoform-collodion dressing. Frequently, in a few hours, the elevations disappear and a uniform swelling closes the urachus. Sodium chlorid solution, 15 per cent, is used. To this a few drops of pure carbolic acid are added. The results appear to be good.

Swain, in the Veterinary Archives for 1903, when referring to persistency of the urachus, says: "The equine family seems much more subject to this abnormality than the bovine or other domestic animals, and the breeds of draft-horses are more subject than the finer breeds; the male foal is more subject to this persistence than the female."

Bland-Sutton, in "Tumors, Innocent and Malignant," 1907, says that he had observed urachal cysts in the horse.

Recently, while conversing with my old friend and classmate, Dr. W. N. Barnhardt, about urachal remains, he told me that for years he had been interested in this subject, and that he had observed numerous abnormalities in the horse. I asked him to give me briefly the results of his observations. Under date of April, 1914, he writes:

"Living for years on a horse-breeder's ranch, I developed a curiosity as to the cause of death of foals. Among other morbid conditions I observed, by postmortem examination, a patent urachus in five foals that had died within four days of their birth. One of these showed a red thrombus about the size and shape of a small banana, and two others showed infection and inflammation within the urachus. In four of them urine had flowed quite freely from the umbilicus. In others that lived and attained a healthy maturity I have observed an occasional discharge of urine at the umbilicus in the first few days after birth."

From the foregoing it is clearly evident that urachal remains, particularly umbilical fistulae, are relatively common in the horse.

Urachal Remains in the Cow or Steer. — Gurlt, in 1831, when referring to a cyst-like pouch of the urachus seated on the top of the bladder and resembling a second bladder in a horse, said that he had once observed a similar condition in a cow. This case was seen in consultation with a veterinary surgeon named Naundorf.

Veiel, in 1862, reported several cases. In the examination of an eleven-day-old steer he found passing from the top of the bladder a urachus which could be traced for 5.6 cm. as a tube. It was 6 mm. broad and had a relatively uniform diameter. Veiel, in Case 3, refers to a sixteen-day-old calf. The top of the bladder gradually diminished in size and passed over into the urachus, which was open as far as the umbilicus.

Bland-Sutton has observed urachal cysts in the ox, in the pig, and in the mole.

Urachal Remains in the Pig. — In a sow one year old, Veiel observed at the top of the bladder a cord 7.3 cm. long and about 2 mm. broad. On carefully splitting the muscle and turning it back, he detected a small lumen. This was uniform in diameter, but at each end was a round dilatation.


REMNANTS OF THE URACHUS. 525

Hoffmann, in 1870, made an interesting observation on cysts of the urachus in a swine embryo. He first referred to an observation by Meckel, who found in a swine at term a cyst of the urachus, one inch in diameter, situated four inches below the umbilicus. At either end it was attached to the urachus.

Hoffmann said that in 1866 he received from a butcher a so-called double urinary bladder. This came from a full-grown pig and had the form of two sacs of the same size, which were separated from one another by a narrowing in the middle. When distended, both halves were elongated and rounded, and it looked as if, on the summit of the portion connected with the urethra, a second bladder was situated. In the distended condition the lower compartment was 31 cm. long and 22 cm. in diameter. The upper one was 25 cm. long and had a breadth of 24 cm. These two cavities occupied the space between the urethra and the umbilicus. Over its entire surface was a peritoneal covering. At the umbilicus the upper portion was closed. The lumen occupying the usually obliterated portion of the urachus had dilated, forming the second bladder.

Sutton observed urachal cysts in the pig.


LITERATURE CONSULTED ON REMNANTS OF THE URACHUS IN ANIMALS. Bland-Sutton, J.: Tumors, Innocent and Malignant, Chicago, 1907.

Finch, R.: Case of Pervious Urachus (in a Colt). Veterinary Record, London, 1902-03, xv, 798. GurJt, E. F.: Path. Anat. der Haus-Saugethiere, 1831, i, 213. Hoffmann, C. E. E.: Zur pathologisch-anatomischen Veranderung des Harnstrangs. Arch.

der Heilkunde, 1870, xi, 373. O'Brien, J. E.: Pervious Urachus, Comparative Anatomy. The Obstetric Gazette, Cincinnati,

1879-80, ii, 100. Salvisberg: Die Behandlung der Urachusfistel beim Fohlen. Sehweizer Arch. f. Thierheilkunde.

1902, xliv, 228. Swain, S. H.: Persistency of the U/rachus. Jour. Compar. Med. and Veterinary Archives, 1903.

xxiv, 95. Veiel, E.: Die Metamorphose des Urachus. Diss., Tubingen, 1862.



Umbilicus (1916): 1 Umbilical Region Embryology | 2 Umbilical Region Anatomy | 3 Umbilical New-born Infections | 4 Umbilical Hemorrhage | 5 Umbilicus Granuloma | 6 Omphalomesenteric Duct Remnants | 7 Umbilicus Abnormalities | 8 Meckel's Diverticulum | 9 Intestinal Cysts | 10 Patent Omphalomesenteric Duct 1 | 11 Patent Omphalomesenteric Duct 2 | 12 Bowel Prolapsus at Patent Omphalomesenteric Duct | 13 Abdominal Wall Cysts by Omphalomesenteric Duct Remnants | 14 Omphalomesenteric Vessels Persistence | 15 Umbilical Inflammatory Changes | 16 Subumbilical Space Abscess | 17 Umbilicus Paget's Disease | 18 Umbilicus Infections | 19 Umbilicus Abnormalities 2 | 20 Umbilicus Fecal Fistula | 21 Umbilicus Round Worms | 22 Umbilicus Foreign Substance Escape | 23 Umbilical Tumors | 24 Umbilicus Adenomyoma | 25 Umbilicus Carcinoma | 26 Umbilicus Sarcoma | 27 Umbilical Hernia | 28 The Urachus | 29 Congenital Patent Urachus | 30 Urachus Remnants | 31 Urachal Remnants Producing Tumors | 32 Large Urachal Cysts | 33 Anterior Abdominal Wall Abscesses | 34 Urachal Cavities | 35 Umbilicus Acquired Urinary Fistula | 36 Urachal Concretions and Urinary Calculi | 37 Urachus Malignant Changes | 38 Urachus Bleeding into the Bladder | 39 Patent Urachus Tuberculosis | Figures

Reference

Cullen TS. Embryology, anatomy, and diseases of the umbilicus together with diseases of the urachus. (1916) W. B. Saunders Company, Philadelphia And London.

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