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Case Reports
. 2017 Aug 10:2017:bcr2017220546.
doi: 10.1136/bcr-2017-220546.

A rare urological presentation of appendicitis

Nick Simson  1 , Thomas Stonier  1 , Alberto Coscione  1 , Ahmed Qteishat  1
Affiliations
Case Reports

A rare urological presentation of appendicitis

Nick Simson et al. BMJ Case Rep. .

Abstract

A 17-year-old boy with no medical comorbidities, but a significant family history of malignancy, presented to Accident and Emergency following 3 days of increasing rectal pain, symptoms of bladder outflow obstruction (poor flow, intermittent stream and hesitancy) and dysuria. Notably he had no abdominal pain. Digital rectal examination revealed a tender, enlarged prostate. Inflammatory markers were significantly raised (white cell count 17.7, C reactive protein 191). He was diagnosed clinically as prostatitis and commenced on intravenous antibiotics. Despite this his pain and inflammatory markers deteriorated, necessitating a CT of his abdomen and pelvis. This demonstrated multiloculated large thick-walled abscesses in the pelvis closely related to the rectum, prostate and seminal vesicles with some bowel wall thickening. Laparoscopy demonstrated a large colonic mass adherent to surrounding structures. The procedure was converted to laparotomy to enable resection of the mass via a limited right haemicolectomy. He recovered well and was discharged. Histopathological analysis of the specimen revealed appendicitis.

Keywords: gastrointestinal Surgery; general surgery; prostate; urinary and genital tract disorders.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Transabdominal ultrasound.
Figure 2
Figure 2
CT abdomen and pelvis demonstrating multi -loculated pelvic collection.
Figure 3
Figure 3
CT abdomen and pelvis.
Figure 4
Figure 4
Histopathological specimen.
See this image and copyright information in PMC

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