Acute urinary retention in a child with appendiceal abscess: diagnostic dilemma

A rare case of an appendiceal mass masquerading as a pelvic tumour and causing bilateral hydronephrosis

Diagnosing acute appendicitis in children can be difficult due to atypical presenting symptoms. While there are reported cases of acute appendicitis or appendiceal masses causing unilateral hydronephrosis, bilateral hydronephrosis as a complication of appendiceal mass is very rare. We report a case of a child who presented with cardinal symptomatology associated with the urogenital tract. Ultrasound (US) investigation showed a pelvic mass causing bilateral hydronephrosis. An initial diagnosis of a pelvic teratoma was made based on the US and computed tomography (CT) scan findings. The final diagnosis of an appendiceal mass causing bilateral hydronephrosis was established intraoperatively.

Acute urinary retention secondary to perforated diverticulitis misdiagnosed as acute prostatitis

Abdominal abscess resulting from a perforated diverticulitis has never been reported as a cause of acute urinary retention. Our patient is the first case to be reported. Because of the atypical presentation, he was initially misdiagnosed and treated as having acute prostatitis. Emergency physicians should have a high index of suspicion. Detailed history, abdominal sonography, and digital examination are helpful in diagnosing this disease.

Acute urinary retention in a 9-year-old child: an atypical presentation of acute appendicitis

Acute urinary retention is unusual in childhood and when present is likely to have an identifiable cause. Although the evaluation is often performed by the urologic specialist after relief of the obstruction, it is imperative that some causes be identified in the Emergency Department. This is a case of a 9-year-old boy in acute urinary retention caused by a ruptured appendix with a periappendiceal abscess.

Acute urinary retention in a child caused by a congenital bladder diverticulum

Acute urinary retention is an uncommon diagnosis in childhood, and is associated with a variety of causes. Congenital bladder diverticula, occurring almost exclusively in boys, is not a rare entity. However, acute urinary retention is an extremely rare complication of congenital bladder diverticulum. A boy with acute urinary retention caused by obstructing bladder diverticula is presented, and the surgical approach is discussed.

The role of renal scintigraphy in the diagnosis and follow-up of unilateral ATN after complete bilateral distal ureteral obstruction as a complication of acute appendicitis

Acute anuria due to bilateral distal ureteral obstruction developed in two boys, ages 7 and 13, several days after appendectomy, without sonographic signs of hydronephrosis or hydroureters. Decompression was achieved after introduction of ureteric stents. This failed on the left side in one patient, and unilateral acute tubular necrosis (ATN) subsequently developed on that side. Although bilateral decompression was successful in the second patient, ATN had already developed on the left side. In both patients, Tc-99m MAG3 renal scintigraphy proved to be an important tool in diagnosing unilateral ATN and for evaluating the recovery from this rare complication.

A rare complication of acute appendicitis: complete bilateral distal ureteral obstruction

Three children treated for appendicitis developed anuria and acute renal insufficiency several days after appendicectomy. Associated hydronephrosis or hydroureters were present in two. At cystoscopy, marked swelling of the trigonum and ureteric orifices was seen. One patient developed unilateral acute tubular necrosis, a complication not reported before. Recognition of this rare complication of acute appendicitis, which need not be accompanied by hydronephrosis, should lead to prompt decompression by the introduction of ureteric stents.

Acute urinary retention: an unusual presentation of appendiceal abscess

Emergency physicians frequently encounter patients with acute urinary retention. Although most common among the elderly, pediatric and young adult patients occasionally may present with this complaint. The differential diagnosis and emergency department work-up must be age specific. We discuss the case of a young man who presented with acute urinary retention, subsequently found to be caused by undiagnosed appendicitis with appendiceal abscess formation. Only nine such cases have been reported in the literature thus far, with only one occurring in the nonpediatric population. This case represents the second such case to be reported. The importance of a thorough history, physical examination, and diagnostic work-up of patients who present with acute urinary retention, particularly those in the younger age group, is emphasized.