Acute pelvic pain: a ball pen may be a cause?

Abstract

Chronic Urinary tract infection (UTI) is a common problem in women and can be seen without any significant anatomical and functional pathology. Foreign bodies within the urinary bladder are not rare and should be considered as a cause of chronic and recurrent UTI. Intravesical foreign bodies can be self inflicted, iatrogenic or migration from adjacent organs. History in these cases is often misleading and presentation of foreign body mostly becomes apparent as suprapubic pain, dysuria with or without hematuria. We present a case of self-inflicted foreign body within the bladder of a young female who presented with recurrent urinary tract infections for six months that did not respond to medical treatment.

Keywords: Computed tomography; Foreign body; UTI; Ultrasonography; Urinary bladder.

[Table/Fig-1]:

Plain radiograph of pelvis shows two metallic density foreign bodies in the pelvic region, of which one was smaller and pointed (arrowhead) and other was larger and tubular (arrow). A low density linear object (red arrow) was seen lying obliquely in the pelvis and appeared to be aligned with the smaller foreign body

[Table/Fig-2a&b]:

Sonography of urinary bladder in oblique transverse section (A) shows an obliquely lined echogenic foreign body of 6.3 cm in length with impacted tip in bladder wall. Sonography of urinary bladder in sagittal section (B) shows an echogenic foreign body of 4.2 cm length at dependent position of lumen.

[Table/Fig-3a&b]:

Oblique sagittal plain computed tomography scan (A) reveals a linear object (arrow)within the urinary bladder with hypodensity at the superior half, isodensity at the inferior half and metallic density pointed tip (arrowhead) indenting the bladder wall. Coronal computed tomography scan through posterior part of urinary bladder (B) showing a tubular metallic density structure resembling a cap of ball pen (arrowhead)