A rare urological presentation of appendicitis.
Nick Simson1, Thomas Stonier1, Alberto Coscione1
1Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK.
BMJ Case Reports
|August 12, 2017
Summary
A young male presented with severe rectal pain and urinary symptoms, initially diagnosed as prostatitis. Imaging revealed pelvic abscesses, leading to surgery that unexpectedly uncovered appendicitis as the cause.
Area of Science:
- Gastroenterology
- Urology
- Surgical Pathology
Background:
- A 17-year-old male with a family history of malignancy presented with acute rectal pain and lower urinary tract symptoms.
- Initial clinical diagnosis was prostatitis, with elevated inflammatory markers (WCC 17.7, CRP 191).
Observation:
- Despite intravenous antibiotics, the patient's condition worsened, prompting abdominal and pelvic CT.
- CT revealed large, multiloculated pelvic abscesses near the rectum, prostate, and seminal vesicles, with bowel wall thickening.
Findings:
- Laparoscopy identified a large colonic mass, necessitating conversion to laparotomy for a right hemicolectomy.
- Histopathological analysis of the resected mass confirmed appendicitis.
Implications:
- This case highlights the importance of comprehensive diagnostic evaluation in complex presentations, even with initial seemingly clear diagnoses.
- Appendicitis can present atypically with pelvic abscesses and symptoms mimicking prostatitis, underscoring the need for advanced imaging and surgical exploration.
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