Acute Appendicitis Presenting As Urinary Retention In A Pediatric Patient

We present a unique case of a two-year-old male patient who presented to our Emergency Department (ED) multiple times with acute urinary retention. On his first ED visit, he had chief complaints of fe ver associated with vomiting, diarrhea and inability to urinate for one day. Patient was vitally stable on arrival and examination was within normal limits. Workup at that time was remarkable for leukocytosis of 21,000 and C Reactive Protein (CRP) of 38.9. Basic Metabolic Panel (BMP) was normal. Urinalysis (UA) showed 4 white cells but nega tive leucocyte esterase or nitrites. Patient was diagnosed with acute gastroenteritis. He received a normal saline bolus of 20 cc/kg, one dose of Ondansetron for vomiting and waslater discharged home. Patient was seen in our outpatient pediatric clinic next day with chief complaint of inability to urinate. His vomiting, diarrhea and fevers improved overnight. On that visit, patient was vitally stable and examination was within normal limits except for palpable dis tended bladder. Workup showed down trending white cell count of 19,200 and CRP of 25.1. BMP was within normal limits. UA showed pyuria with 7 WBCs, 3 RBCs but negative leucocyte esterase and nitrites. Urine culture was obtained as well. Patient was catheterized in clinic where he produced approximately 140 ml of urine. On repeat