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

10. 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

11. 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

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

17. Histopathology

18. 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

19. Thank You