%0 Journal Article
%T Missed Appendicitis: Mimicking Urologic Symptoms
%A Hamed Akhavizadegan
%J Case Reports in Urology
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/571037
%X Appendicitis, a common disease, has different presentations. This has made its diagnosis difficult. This paper aims to present two cases of missed appendicitis with completely urologic presentation and the way that helped us to reach the correct diagnosis. The first case with symptoms fully related to kidney and the second mimicking epididymorchitis hindered prompt diagnosis. Right site of the pain, relapsing fever, frequent physical examination, and resistance to medical treatment were main clues which help us to make correct diagnosis. 1. Introduction It is a rule in every medical ward to warn medical students about missing appendicitis, a lethal mistake. However, it is not very uncommon to see the complications of perforated appendicitis, missed by trained specialists. So writing about appendicitis is old, however, not useless. Appendicitis is great mimicker, as it was said by William Osler for Syphilis. This paper is to present two cases that can exemplify this reality. 2. First Case Presentation A twenty-five-year-old man was admitted to the emergency room with fever and severe right flank pain. After the initial evaluation and resuscitation, cultures were provided and empirical antibiotic therapy with ceftriaxone was started. He had a history of stone passing two years ago, thus in this episode, he had tried analgesics, hydration, and exercise four days before his current admission. Nevertheless, the fever had made him seek medical visit. His chief complaint was severe right flank pain which was too intense to let him pose for assessment of costovertebral angle tenderness and very little pain if any in right lower quadrant (RLQ). The ultrasound of kidney, ureter, and bladder revealed only a 3£¿mm calyceal stone. Spiral CT scan without contrast of abdomen and pelvis was requested to detect any probable small missed ureteral stones. The CT scan did not reveal any ureteral stones; however, right perinephric fat was unusual, losing the sharp normal lower border (Figure 1). For ruling out the diagnosis of forniced rupture, an intravenous pyelography (IVP) was ordered. In the second day of admission, the patient¡¯s body temperature returned to normal and IVP was normal, but the flank pain extremely increased. The cultures were negative and U/A was inactive. Afterwards, the patient developed fever again. Reexamination showed peritoneal irritation localized to RLQ. In laparotomy, perforated retrocecal appendicitis with draining pus to the jerota was revealed. After appendectomy, because of massive volume of pus coming out of jerota, a three-way urinary
%U http://www.hindawi.com/journals/criu/2012/571037/