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 -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

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

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

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

Investigations Abd x-ray : unremarkable

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

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

Post-op Uneventful recovery Discharged on 3 rd day post op

Histopathology

Tumor marker LDH : 404 ( U/L ) B-HCG : 0.7 (0-5 IUI/L AFP : 1.7 ( <10 ) Pt was shifted to KCC

Thank You