Divertículo vésico-uracal en paciente adulto: reporte de caso y revisión de la literatura con enfoque imagenológico

Urachal remnants are rare congenital anomalies, present in 1.6% of children under 15 years of age and 0.6% of adults, with a prevalence of 2% in the general population. However, studies indicate that they may be more frequent. Clinically, they may manifest through recurrent urinary tract infections, hematuria and nonspecific abdominal pain, in addition to a risk of malignant transformation. Urachal diverticulum, a rare variant that represents 3-5% of urachal pathologies, can cause complications such as infections, stone formation and, in severe cases, perforation or malignant transformation, mainly after puberty. Imaging techniques, such as ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI), are essential for their diagnosis and characterization, offering key anatomical and functional details. Regarding malignant neoplasms, urachal adenocarcinomas represent 80% of malignant neoplasms of this structure and less than 1% of total bladder neoplasms. Their diagnosis is late due to their initial asymptomatic course and aggressive behavior, with a tendency to invade local structures and generate metastases. The standard treatment is complete surgical resection of the remnant, especially in symptomatic or suspected malignant cases. Laparoscopic surgery offers good results, although in selected cases conservative management with antibiotic therapy and regular monitoring may be considered. This multidisciplinary approach guarantees optimal management of these rare and potentially serious pathologies.