CASE PRESENTATION: A 14-year-old boy presented to our institution with peri-umbilical swelling and purulent discharge from his umbilicus for 2 weeks duration. There were no radiological, microbiological or clinical evidences of TB in the initial presentation, though he had close social contact with someone who had TB. A computed tomography scan of the abdomen confirmed the diagnosis of an urachal abscess. An incision and drainage procedure was performed followed by a course of antibiotics. A scheduled laparoscopic approach later showed that the peritoneum and serosal surface of the small and large intestines were studded with nodules of variable sizes, in addition to the urachal sinus. The histology of the resected tissues (urachal sinus and nodules) was consistent of TB infection. He recovered fully after completing 6 months of anti-tuberculous therapy.
CONCLUSION: This report highlights a rare case of TB urachal abscess in an adolescent boy, the difficulties in the diagnosis of abdominal tuberculosis, the need to consider TB as a cause of urachal infection in endemic areas and the use of laparoscopy in both diagnosis and treatment.
METHODS: A retrospective review was performed on a group of paediatric population aged 0 till 12 years of age, with a history of admission to paediatric ENT ward from the year 2010 till 2015 in HTJS. Initially, 69 children with the diagnoses of various neck infections were identified. Then, the sample amount was narrowed to 30 patients with neck abscesses only.
RESULTS: The data analysis was performed using descriptive statistics, Chi-squared test and Fisher's exact test. Twentyfive out of the 30 patients required operative drainage of abscess (83.3%). In this group, children aged ≤2 years old were the largest group to have undergone surgical drainage. Only five patients were successfully treated with antibiotic therapy alone. Nineteen children came only after developing neck swelling for more than a week, in which 18 of them required surgery.
CONCLUSION: Younger group of children are more likely to undergo surgical drainage than older children for neck abscess. Also, children who came in after two weeks of symptoms have a higher probablity of requiring surgery than antbiotic alone. Nonetheless, every child who comes in with neck abscess should be evaluated and treated early to avoid any sinister complications.