Ureterolithiasis accompanied by acute appendicitis.

A report describes a case of a 12-year-old girl who presented with a four-day history of vomiting and worsening pain in the right flank and periumbilical region. 

Physical examination showed a body temperature of 37.6 °C and right lower quadrant tenderness with slight guarding and rebound and costovertebral angle tenderness. 

Blood test results demonstrated a normal white blood cell count with neutrophilia of 77.8 %, normal urinary function, and slightly elevated C-reactive protein. 

Urinalysis results showed dipstick hematuria of 3+ and microscopic erythrocytes of 1–4 /high- powered field. 

Enhanced abdominal computed tomography (CT) illustrated thickening of the appendix measuring 8.0 mm and a calculus measuring 4.2 mm at the right vesicoureteral junction along with moderate hydronephrosis. 

The patient received a clinical diagnosis of acute appendicitis associated with obstructive ureterolithiasis. She received a successful treatment with intravenous cefmetazole and hydration with the resolution of abdominal pain and hydronephrosis after spontaneous ureteric stone passage on day 4. 

Amino acid analysis of the urine specimen collected at admission revealed an elevated cystine level; thus, she received a diagnosis of Cystinuria based on stone analysis and increased urinary secretion of cystine.

The patient also received a schedule for an interval appendectomy two months later. She was advised adequate fluid intake and potassium citrate administration for the prevention of recurrent stone formation, along with regular check-ups.

Hiraoka T, et al. A pediatric case of ureterolithiasis due to Cystinuria accompanied by acute appendicitis; a case report. International Journal of Surgery Case Reports. 2022; 99. https://doi.org/10.1016/j.ijscr.2022.107596.