Case PresentationDr. ALI ALAMIRIUrology Dept.–AlFarwaniya Hosp.R2

Case - 40 yrs old Egyptian male presented with

abdominal pain - Pain

- Woke- up from sleeping because of sudden onset pain - Duration of pain: 24 hours- Mainly RIF+suprapubic - Dull achy pain- Moderate to severe- Not radiating- Not associated with vomiting, dysuria- No hx of trauma - No hx of diarrhea or constipation - No hx of melena or hematochezia - No hx of fever- No similar attack before

History

•Medication : non , no allergy •PMH: non•PSH: non •Family Hx : not significant •Not smoker

O/E•Vital signs :

▫Temp : 37.9c BP : 115/75 P : 90/min•Pt was in severe pain •Abdomen :

▫distended ▫Guarding ▫Severe RIF tenderness ( +ve rebound

tenderness) ▫Palpable mass in RIF+suprapubic ▫+ve bowel sound

•Scrotal examination ▫Single lt. testis ( empty hemiscrotum )

•DRE : unremarkable

Investigations•CBC : Hgb: 113 g/L WBC : 9.6

PLT : 204

•RFT : Creat : 97 µmol/L K: 3.8 mol/L

•LFT : N

•Coagulation profile : N

•Urine analysis : N

Investigations•Abd x-ray : unremarkable

CT Report •Large exophytic , mesenteric mass in

suprapubic region (13 x 11 x 8 cm ) surrounded by mesenteric stranding andmultiple abdominal L.N

• most likely infected giant diverticulum

Management •Pt shifted to OT for exploration by general

surgery and consulted urology team to be with them ( diverticulitis VS intra-abdominal testicular torsion )

•Urology team started with D/L

Post-op •Uneventful recovery •Discharged on 3rd day post op

Histopathology

Tumor marker

•LDH : 404 ( 100-190 U/L )•B-HCG : 0.7 (0-5 IUI/L•AFP : 1.7 ( <10 )

•Pt was shifted to KCC

Thank You