The Case Files: ‘It Whistles When I Pee’

Price, James; Bachmann, Daniel MD; Neltner, Kurt MD; Dick, Mike MD A 65-year-old man presented to the emergency department with a chief complaint of “it whistles when I pee.” The patient complained of a two-day history of gross hematuria and dysuria but denied flank, back, and abdominal pain. He described a two-week history of air coming from the urethral meatus at the end of urination. He also reported that he had been treated with ciprofloxacin for two weeks for a urinary tract infection, which he finished one week prior to presentation. The patient had been seen five months previously with diverticulitis and perforation, resulting in a small abscess that responded to conservative treatment with IV antibiotics. The patient's history was also significant for a gunshot wound to the abdomen 39 years before, which was treated with exploratory laparotomy, small bowel resection, and primary anastomosis. He had no abdominal tenderness or genitourinary or other abnormalities. Urinalysis was positive for large amounts of blood, protein, nitrites, bacteria, and leukocyte esterase. A CT scan of the abdomen with contrast demonstrated evolving diverticular abscess with tiny connections between the sigmoid colon lumen and lumen of the bladder, which represents fistula formation. Evidence of cystitis and air in the bladder was also seen. The patient was started on IV piperacillin-tazobactam in the emergency department and was evaluated by surgery, resulting in admission to the hospita...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research