A 55-year-old man with a history of chronic constipation presented to the Emergency Department (ED) with 1 week of worsening constipation, dysuria, and lower abdominal pain. The patient had just completed a 7-day course of ciprofloxacin for a urinary tract infection, prescribed by his primary care physician. The patient denied any fevers, chills, nausea, vomiting, flank pain, rectal bleeding, or hematuria. On examination, his vital signs were normal. Physical examination was significant for a well-appearing man with suprapubic and lower abdominal fullness and tenderness with no rebound or guarding. There was no flank tenderness. On rectal examination, the prostate was non-tender and of normal contour and size. Because the diagnosis of urinary retention remained in the differential diagnosis, an ED ultrasound was obtained; it revealed a round, echogenic density. Laboratory values including electrolytes, creatinine, hemoglobin, and white blood count were within normal limits. Urinalysis showed strongly positive leukocyte esterase and many red and white blood cells. A computed tomography (CT) scan of the abdomen and pelvis without oral or intravenous contrast was ordered.
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Published online: April 06, 2009
Accepted: February 5, 2009
Received in revised form: December 13, 2008
Received: September 29, 2008
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.