- Email: [email protected]
Case profile: Unusual foreign body producing renal colic
URORADIOLOGY
CASE PROFILE: UNUSUAL FOREIGN BODY PRODUCING RENAL COLIC 1PROFILE A forty-six-year-old man was referred for evaluation because of right flank pain and right lower quadrant tenderness of one day’s duration. He denied any prior urologic dysfunction, and his past history revealed that he had had an appendectomy and a vasectomy. One year prior to this admission the patient had been placed on lithium carbonate therapy for depression. Findings on physical examination revealed right flank and right lower quadrant tenderness and guarding. Fullness was noted at the site of his appendectomy scar. Urinalysis revealed albuminuria and microhematuria. A plain film of the abdomen revealed a foreign body, possibly a retained surgical instrument (Fig. 1A). The patient vigorously denied ingesting or inserting any foreign bodies. An intravenous pyelogram the following day clarified the problem. The foreign body had migrated and with the change in position and appearance could be identified as the temple or ear pieces of eyeglasses (Fig. 1B). Minimal deviation of the right ureter was noted on the pyelogram, but no hydronephrosis was present. In the interim the renal colic had subsided and the clinical picture clarified.
1
The patient continued to deny any responsibility, and in fact was vociferous in his belief that the instrument had been misplaced at the time of his appendectomy. Eventually he quietly confessed that while hospitalized in a local psychiatric facility four years earlier, in an aborted suicide attempt, he had swallowed the temple segment of his eye glasses. Fortunately, the temple pieces were retrieved by colonoscopy without adverse sequellae. This case illustrates not only an unusual foreign body but also a not infrequently encountered differential problem in evaluating right flank tenderness. The presence of the foreign body in the cecum or its passage through the ileocecal area, may have produced sufficient inflammation to simulate the effect often found with a retrocecal appendicitis. Once the foreign body had migrated to the ascending colon beyond, no further pain or microscopic hematuria was found. John E Maynard, M.D. Department of Urology Rhode Island Hospital 110 Lockwood Street Providence, Rhode Island 02903
FIGURE 1. (A) Metallic densities in right lower quadrant simulating surgical clamp. (B) Intravenous pyelogram demonstrating medial deviation of right ureter and two linear foreign bodies overlying right side of abdomen.
664
UROLOGY
/
DECEMBER
1983
/
VOLUME
XXII,
NUMBER
6
CASE PROFILE: UNUSUAL FOREIGN BODY PRODUCING RENAL COLIC 1PROFILE A forty-six-year-old man was referred for evaluation because of right flank pain and right lower quadrant tenderness of one day’s duration. He denied any prior urologic dysfunction, and his past history revealed that he had had an appendectomy and a vasectomy. One year prior to this admission the patient had been placed on lithium carbonate therapy for depression. Findings on physical examination revealed right flank and right lower quadrant tenderness and guarding. Fullness was noted at the site of his appendectomy scar. Urinalysis revealed albuminuria and microhematuria. A plain film of the abdomen revealed a foreign body, possibly a retained surgical instrument (Fig. 1A). The patient vigorously denied ingesting or inserting any foreign bodies. An intravenous pyelogram the following day clarified the problem. The foreign body had migrated and with the change in position and appearance could be identified as the temple or ear pieces of eyeglasses (Fig. 1B). Minimal deviation of the right ureter was noted on the pyelogram, but no hydronephrosis was present. In the interim the renal colic had subsided and the clinical picture clarified.
1
The patient continued to deny any responsibility, and in fact was vociferous in his belief that the instrument had been misplaced at the time of his appendectomy. Eventually he quietly confessed that while hospitalized in a local psychiatric facility four years earlier, in an aborted suicide attempt, he had swallowed the temple segment of his eye glasses. Fortunately, the temple pieces were retrieved by colonoscopy without adverse sequellae. This case illustrates not only an unusual foreign body but also a not infrequently encountered differential problem in evaluating right flank tenderness. The presence of the foreign body in the cecum or its passage through the ileocecal area, may have produced sufficient inflammation to simulate the effect often found with a retrocecal appendicitis. Once the foreign body had migrated to the ascending colon beyond, no further pain or microscopic hematuria was found. John E Maynard, M.D. Department of Urology Rhode Island Hospital 110 Lockwood Street Providence, Rhode Island 02903
FIGURE 1. (A) Metallic densities in right lower quadrant simulating surgical clamp. (B) Intravenous pyelogram demonstrating medial deviation of right ureter and two linear foreign bodies overlying right side of abdomen.
664
UROLOGY
/
DECEMBER
1983
/
VOLUME
XXII,
NUMBER
6