Occult urinary tract obstruction presented as ileus YiJen
Occult urinary tract obstruction presented as ileus Yi-Jen Chen, Wei Chen Division of chest and critical care, department of internal medicine, Ditmanson medical foundation Chia-Yi Christian hospital Introduction Urinary tract obstruction was a common problem in the patient at hospital. The clinical manifestations vary with the site, rapidity and severity of the obstruction. Because of distention of bladder and collect system, pain is often complained. In addition, low urine output was another clue to the physician. Herein, we presented a patient with ileus as the initial manifestation of distended bladder. Case presentation This was a 78 year-old female patient. She was admitted due to fell down and left femoral intertrochanteric fracture. From history taking, she denied history of diabetes mellitus nor other major systemic disease. Her muscle power and movement of four limbs were normal before this admission. Her urine analysis, renal function test, electrolyte and liver function test were within normal range. After close reduction and internal fixation with dynamic hip screw, she complained of poor appetite and constipation in the ward. Prokinetic agent was prescribed but the symptoms were not resolved. Abdomen physical examination showed flat abdomen but a palpable mass found in the lower abdomen. Abdominal computed tomography was done and it showed large distended urinary bladder with bilateral hydronephrosis (Fig 1 and Fig 2). Then foley tube was inserted and the symptoms were relieved. Discussion Distended bladder maybe painless if it developed slowly or in the flaccid neurogenic bladder. However, it may cause compression to rectum or rectosigmoid junction and result in ileus. In the clinic practice, uncommon ileus complaint should arise our suspicion of the possibility of urinary tract obstruction.
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