[Acute abdomen caused by a large vesical cystine calculus]

A 73-year-old man underwent an emergency laparotomy because of acute abdominal pain and a palpable mass in the lower abdomen. A giant vesical calculus was found which had perforated the bladder, small intestine and sigmoid colon due to pressure necrosis. The stone had a length of 11.5 cm and weighed 1280 g. Further analysis revealed benign prostate hyperplasia, bladder diverticula and cystinuria as underlying causes. Initial therapy consisted of stone removal, partial bladder resection, a Hartmann procedure and partial resection of the small intestine. Secondarily, lifestyle advice was given and transurethral resection of the prostate followed later.