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    Challenging cases in urology: A case of hydronephrosis, sepsis, and pain

     

    Repeat lab work

    Repeat lab work revealed a leukocytosis that was now 17.5 thou/µL. Given this finding and her persistent intermittent abdominal pain, a repeat CT scan was ordered. This showed the right ureteral stent in good position, improved hydronephrosis, and a markedly dilated appendix with surrounding stranding consistent with acute appendicitis (figures 3 and 4).

    The patient was seen by general surgery and ultimately taken to the operating room for laparoscopic appendectomy. Intraoperatively, she was found to have a large, inflamed appendix with a perforation at the base and purulent ascites (figure 5). Her final urine culture was negative.

    One month after the initial stent placement, the patient was re-evaluated. She was asymptomatic and KUB revealed no ureteral calcification. The stent was removed without issue.

    Figure 3. Repeat CT scan showed a well-positioned ureteral stent, no hydronephrosis, dilated appendix and an appendicolith. (Photo courtesy of Sara Valente, MD)

    Figure 3. Repeat CT scan showed a well-positioned ureteral stent, no hydronephrosis, dilated appendix and an appendicolith.

    Figure 4. Repeat CT shows right ureteral stent marking the true position of the right ureter. (Photo courtesy of Sara Valente, MD)

    Figure 4. Repeat CT shows right ureteral stent marking the true position of the right ureter.

    Figure 5. Intraoperative image revealing a perforation at the base of the appendix and purulent ascites. (Photo courtesy of Sara Valente, MD)

    Figure 5. Intraoperative image revealing a perforation at the base of the appendix and purulent ascites.

    Next: Discussion of case, stone management

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