Prostate abscess causing obstruction in an emergency department patient with constipation

Background

Prostate abscess differs from prostatitis as a complicated infection requiring appropriate early treatment. It typically presents with urinary symptoms plus rectal or pelvic pain in middle-aged or older men. Diabetic, immunosuppressed, or patients with urological procedures are at higher risk for serious infection. If untreated, prostate abscess can progress to critical illness including sepsis and death, thus early diagnosis and treatment is key.

Case report

A middle-aged male with diabetes, hypertension, emphysema, and hypothyroidism presented with severe constipation for one week but no urinary symptoms, fever, or vomiting. On examination, he had mild abdominal distension without tenderness, decreased bowel sounds, and a normal external rectal exam. Computed tomography scan demonstrated prostatomegaly and a large 5.2cm prostate abscess with multiple lobulations causing mass effect on the distal colon, thus blood cultures were sent, intravenous antibiotics started, and urology consulted. The patient was admitted for continued antibiotic treatment and underwent surgical transurethral resection with urology the next day. A foley catheter was maintained for seven days, with improvement until hospital discharge 3 days later, with oral antibiotics and close urology clinic follow up.

Why should an emergency medicine physician be aware of this?

Prostate abscess is difficult to diagnose clinically and can lead to severe illness without early recognition and treatment. Patients may present with pelvic or rectal pain plus fever or urinary symptoms. Urgent antibiotic therapy is key, and many patients require urology consultation for surgical or procedural management.