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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References
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- Bladder stones.(Accessed September 30, 2008)
- Lower urinary tract calculi.in: Wein A.C. Kavoussi L.R. Novick A.C. Partin A.W. Peters C.A. Campbell-Walsh urology. 9th edn. WB Saunders, Philadelphia, PA2007: 2663-2673
Article info
Publication history
Published online: April 06, 2009
Accepted:
February 5,
2009
Received in revised form:
December 13,
2008
Received:
September 29,
2008
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
