# Pseudoaneurysm in the abdominal wall as a rare complication following surgery of a chronically superinfected urachal malformation — An exceptional case in congenital malformation surgery

## TL;DR

This paper reports a rare case of a pseudoaneurysm in a child following surgery for a urachal malformation, emphasizing the importance of early diagnosis and appropriate treatment.

## Contribution

The paper presents a unique clinical case linking chronic superinfection of a urachal malformation to the development of a postoperative pseudoaneurysm in a child.

## Key findings

- Pseudoaneurysms are rare in children and can be life-threatening if ruptured.
- Chronic superinfection of a urachal malformation may lead to postoperative pseudoaneurysm formation.
- Early imaging and surgical excision are recommended for atypical umbilical malformations to prevent complications.

## Abstract

A pseudoaneurysm, or aneurysma spurium, occurs due to a paravasal hematoma following a vascular injury. Pseudoaneurysms are extremely rare in children and adolescents. Because of the persistent blood flow through the supplying vessel, a potential rupture can cause life-threatening bleeding. Accurate diagnosis and treatment are therefore essential.

We present the case of an 11-month-old female infant with a congenital, exophytically growing, secreting tumor in the umbilical area. Surgical excision revealed a persistent urachus with a urachal cyst and a malformation on the bladder wall. Postoperatively, severe wound healing disorder developed, along with an intra-abdominal abscess. A pseudoaneurysm in the abdominal wall was incidentally detected with sonography, and CT confirmed perfusion from a branch of the right iliac artery. Initial catheter-based endovascular coiling was unsuccessful, and re-laparotomy for ligation, resection of the pseudoaneurysm, and debridement of the abscess was performed. The further course was complication-free.

Pseudoaneurysms, especially post-traumatic ones, can easily be misdiagnosed as a rare differential diagnosis in children and adolescents. Early diagnosis and interdisciplinary treatment are crucial for a successful outcome.

In this particular case, it is assumed that the pseudoaneurysm developed as a result of chronic superinfection of the atypical urachal malformation.

•Early sectional imaging should be considered for atypical umbilical malformations.•Surgical excision is the treatment of choice for umbilical malformations to prevent complications.•Open excision is preferred for pseudoaneurysms, while endovascular treatment is reserved for selected cases.

Early sectional imaging should be considered for atypical umbilical malformations.

Surgical excision is the treatment of choice for umbilical malformations to prevent complications.

Open excision is preferred for pseudoaneurysms, while endovascular treatment is reserved for selected cases.