Case Report: Two cases of urachal abscess misdiagnosed as gynecologic tumors in women

Urachal abscess is a rare infectious lesion originating from persistent urachal remnants and often presents with non-specific pelvic mass manifestations. Owing to overlapping imaging features with pelvic gynecologic neoplasms, misdiagnosis frequently occurs. We report two cases of urachal abscess initially misdiagnosed as gynecologic tumors. One patient underwent laparoscopic exploration and partial bladder wall resection, with pathological confirmation of urachal abscess; the second patient was diagnosed by magnetic resonance imaging (MRI) and cystoscopy. Preoperative MRI in Case 2 raised suspicion of bladder wall invasion and possible malignancy, which informed the initial decision for hysterectomy and adnexectomy. After infection control, radical resection was recommended, but the patient declined definitive surgery due to social factors and selected conservative management with abdominal short-wave magnetic therapy, and remained asymptomatic at follow-up. Clinicians should consider urachal abscess in the differential diagnosis of pelvic masses adjacent to the bladder dome to prevent misdiagnosis and suboptimal management.