Acute Pelvic Pain: A Ball Pen May Be a Cause?

Abstract

An 18-year-old young unmarried female presented with the complaints of severe lower abdominal pain, dysuria and mild fever. On physical examination patient was febrile and restless with mild suprapubic tenderness. No other findings were detected per abdominal examination.Plain radiograph of abdomen was performed which showed two metallic density foreign bodies in the pelvic region, of which one was smaller & pointed and other was larger and tubular. A low density linear object was seen lying obliquely in the pelvis and appeared to be aligned with the smaller foreign body [Table/ Fig-1]. Transabdominal sonography was performed which revealed a 6.3cm long tubular object in the bladder lumen which was lying obliquely. The tip of the object was hyperechoic and appeared impacted in the right lateral bladder wall. Remaining part of the object was isoechoic with smooth margins. Another hyperechoic object was noted in dependent portion of bladder lumen on left side with posterior acoustic shadowing . Innumerable low level floating echoes were noted in distended urinary bladder with thickened and irregular posterior wall. Plain CT scan of lower abdomen [Table/Fig3a&b] showed a long tubular low density structure lying obliquely in the bladder lumen with high density pointed tip. The shape of the structure resembled a ball point pen. Other high density tubular foreign body was noted at dependent part resembling the cap of pen. Pointed tip had invaded the right posterolateral wall of bladder with subsequent focal thickening. Cystoscopic removal of foreign body has been performed and a ball pen and its cap have been taken out without any surgical or post surgical complication. DisCussionForeign body in urinary tract is not uncommon however data regarding exact incidence of occurrence in India or worldwide is not available. Only single case reports or case series are available in medline search. Rafique M in Urol J reported 17 cases of intravesical foreign body over five years [1].Self inflicted foreign bodies in urinary bladder rarely present directly; rather they present with lower urinary tract symptoms like dysuria, lower abdominal pain with or without fever. One major difficulty in the early diagnosis is due to patients who choose to ignore the insertion of foreign body because of embarrassment [2]. There is aBstRaCt Chronic Urinary tract infection (UTI) is a common problem in women and can be seen without any significant anatomical and functional pathology. Foreign bodies within the urinary bladder are not rare and should be considered as a cause of chronic and recurrent UTI. Intravesical foreign bodies can be self inflicted, iatrogenic or migration from adjacent organs. History in these cases is often misleading and presentation of foreign body mostly becomes apparent as suprapubic pain, dysuria with or without hematuria. We present a case of selfinflicted foreign body within the bladder of a young female who presented with recurrent urinary tract infections for six months that did not respond to medical treatment.ke...