Intrauterine devices (IUD) have proven to be one of the most reliable methods of contraception. However, as it is a foreign body, it can migrate from the intended position in the uterus, perforating surrounding structures and creating fistulas. We report a case of a 42-year-old woman who presented with abdominal pain, recurrent urinary tract infections, and chronic pelvic pain for eight years. Imaging revealed an intravesical IUD with attached bladder calculus, and a transurethral cystolitholapaxy subsequently uncovered an enterovesical fistula. Conservative urethral catheter management did not resolve the fistula, which was then repaired via robotic excision. The patient had an uncomplicated postoperative course, and voiding cystourethrogram confirmed water-tight repair of the fistula tract after two weeks.
Diagnosis and treatment for Functional Neurological Symptom Disorder (FND) is often complicated by the insidious nature of clinical presentation, especially in the pediatric presentation. This case depicts an adolescent male who presented for an overdose secondary to ongoing FND symptoms. The patient had concurrent urinary retention leading to infection and transfer to the emergency department. He was subsequently discharged home with minor changes made to his treatment plan. This case highlights a unique representation of a somatic symptom disorder with physiologic presentation, which depicts the importance of recognizing risk factors in the pediatric population. Better recognition of at-risk patients could improve treatment options, outcomes, and minimize time to diagnosis and disruption in care.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.