Urological Causes Mimicking Acute Abdomen: Diagnostic Challenges in General Surgical Emergency Practice

Background Urological disorders are important differential diagnoses in patients presenting with an acute abdomen to a general surgical emergency unit. Conditions such as ureteric colic, obstructive uropathy, acute pyelonephritis, urinary retention, renal trauma, and testicular torsion may simulate appendicitis, intestinal obstruction, biliary colic, or perforation peritonitis. This clinical overlap may delay correct diagnosis, particularly when urinary symptoms are subtle or absent. This study aimed to assess the pattern of urological conditions mimicking acute abdomen and the diagnostic difficulties encountered during initial surgical evaluation. Materials and methods This hospital-based observational study included patients who presented with acute abdominal pain to the general surgery emergency department and were later confirmed to have a urological cause. Data regarding age, sex, presenting symptoms, initial clinical impression, urine findings, renal function tests, ultrasonography, computed tomography findings, final diagnosis, treatment given, and outcome were recorded and analyzed. Results A total of 80 patients were included. Most patients were male subjects (n=56; 70%), and the commonest age group was 31 to 50 years (n=34; 42.5%). Acute abdominal pain was present in all patients, followed by vomiting 42.5%, fever 32.5%, dysuria 28.8%, flank pain 45.0%, and hematuria 21.3%. The most frequent urological cause was ureteric calculus with ureteric colic (n=36; 45.0%), followed by acute pyelonephritis (n=14; 17.5%), obstructive uropathy (n=11; 13.8%), acute urinary retention (n=8; 10.0%), renal or ureteric trauma (n=6; 7.5%), and testicular torsion presenting as lower abdominal pain (n=5; 6.2%). At first assessment, 31 (38.8%) patients were suspected to have a primary general surgical condition. Ultrasonography supported the diagnosis in 58 (72.5%), while computed tomography was required in 29 (36.3%) patients. Conservative treatment was sufficient in 44 (55%) patients and 36 (45%) required urological intervention. Conclusion Urological emergencies can closely resemble acute surgical abdomen. Careful urinary history, focused examination, urine analysis, renal function assessment, ultrasonography, and selective computed tomography help in early diagnosis and prevent unnecessary surgical intervention.