A 79-year-old man with a medical history significant only for hypertension and urinary retention secondary to an enlarged prostate presented to the emergency department with abdominal pain, distension, nausea, and feculent emesis for 3 days. He denied bowel movements or flatus during this time. He denied hematochezia and melena. He was afebrile and had no dysuria or hematuria. He was voiding freely at this time. On physical examination, his abdomen was distended and firm without overt rebound or guarding, but otherwise he appeared well. There were no visible surgical scars on his abdomen. Digital rectal examination revealed a severely enlarged, firm prostate. Notable laboratory values include a normal leukocyte count and a normal creatinine. Prostate-specific antigen (PSA) was not performed upon presentation, but a recent outpatient PSA was noted to be 11.4 ng/dL. Reportedly, the patient underwent a transurethral resection of the prostate approximately 4 years previously at an outside hospital, but records were unable to be obtained. Two months previously, the patient underwent diagnostic cystoscopy, which revealed a severely enlarged prostate and trabeculated bladder with multiple diverticuli. Biopsy of the bladder mucosa revealed a benign urothelium.
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Published online: November 06, 2017
Accepted: October 19, 2017
Received: September 11, 2017
Financial Disclosure: No relevant disclosures or conflict of interests exist for any of the authors.
© 2017 Elsevier Inc. All rights reserved.