35 Urachal fistula

Donor: Dr. John McCrae
Date: 1907
Size (H x W x D cm): 18 x 6 x 6

The bladder is enlarged and is continuous superiorly via a narrow fistula with the abdominal wall at the umbilicus (A, arrow).


A. Click on image to enlarge.

History: Four month-old boy with multiple congenital anomalies (including cryptorchidism and patent ductus arteriosus).

Comment: The upper portion of the developing urinary bladder (derived from the primitive urogenital sinus) is initially continuous with the allantois. Normally, the latter becomes obliterated at about the 12th week of gestation, leaving a fibrous cord (the urachus or median umbilical ligament). Occasionally, a portion of this cord remains patent, forming an isolated cyst, a diverticulum continuous with the bladder, a sinus tract extending from the umbilicus, or a fistula joining the bladder and umbilicus. In the last circumstance (urachal fistula), urine drains exteriorly via the umbilicus. Cysts are usually unassociated with symptoms or complications; the other anomalies can be associated with infection.

The donor of this specimen was John McCrae, the Canadian physician best known for his World War I poem “In Flanders Field”. In the early 1900s, he was pathologist at the Montreal General, Royal Victoria and Montreal Foundling and Baby Hospital; it is uncertain from which of these the specimen originated.

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