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CASE REPORT
A rare urological presentation of appendicitis
  1. Nick Simson,
  2. Thomas Stonier,
  3. Alberto Coscione,
  4. Ahmed Qteishat
  1. Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
  1. Correspondence to Dr Nick Simson, njsimson{at}gmail.com

Summary

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.

  • general surgery
  • prostate
  • gastrointestinal Surgery
  • urinary and genital tract disorders

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Footnotes

  • Contributors All coauthors have made substantial contribution to this case report. NS: the admitting doctor on the team and wrote the majority of the case report. TS: helped with planning, writing of the case and proofreading. AC: responsible for the care of the patient and made significant contribution in editing the paper. AQ: responsible consultant for the care of the patient; was heavily involved with the writing of the case report and always contactable to discuss any issues.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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