A 13-year-old boy with no relevant personal history.
A brother who died of Wilms tumor stood out as a relevant family history.
She presented with voiding symptoms (dysuria, pollakiuria) without other symptoms.
Urine dipstick was negative.
Treatment was initiated with trimethoprim-methotoxazole until the urocultive result was obtained, which was reported as sterile.
The absence of improvement after one week, came to the emergency department.
In the anamnesis associated voiding symptoms and anuria of 18 hours of evolution, together with abdominal pain located in the hypogastrium and the right iliac fossa.
She had no history of surgery or fever since the onset of symptoms.
On physical examination, the patient was in good general condition, with no signs of withdrawal symptoms, and remained within normal limits.
Cardiopulmonary auscultation was normal.
Abdominal examination revealed tenderness of the hypogastrium and right iliac fossa with local signs of peritoneal irritation.
There was no bladder balloon.
The rest of the examination showed no relevant findings.
Analytical tests showed no relevant findings: leukocytes 5400 μl, neutrophils 2370 μl (44%), hemoglobin 13.9 mg/dl, C-reactive protein <2.9 mg/l.
An abdominal X-ray showed no abnormalities, and an abdominal ultrasound showed no urinary tract findings, with virtually empty bladder.
However, an 8 mm thickened appendix with periarticular loose fluid and fat thickening was visualized; findings consistent with acute colitis.
1.
Intravenous fluid infusion was performed under expansion regime, achieving adequate diuresis in a short time.
Given the diagnosis of acute colitis, the patient was operated under general anesthesia with phlegmonous colitis and a phlegmonous cystectomy was performed.
The subsequent evolution was favorable without postoperative complications.
