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Case Presentation

Case Presentation. Dr. ALI ALAMIRI Urology 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

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Case Presentation

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  1. Case Presentation Dr. ALI ALAMIRI Urology Dept.–AlFarwaniya Hosp. R2

  2. 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

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

  4. 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

  5. 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

  6. Investigations • Abd x-ray : unremarkable

  7. 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

  8. 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

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

  10. Histopathology

  11. 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

  12. Thank You

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