Acute urinary retention in the elderly: an unusual presentation of appendicitis with a high perforation risk.

BACKGROUND

Urological manifestations are rare in acute appendicitis. Although acute urinary retention (AUR) is more commonly found in elderly patients, any previous cases reported have been under the age of 30.

OBJECTIVE

The aim of this study was to investigate the incidence, clinical presentation, and results of adult appendicitis patients presenting with AUR. AUR is defined as the sudden inability to urinate with obstructive symptoms.

METHODS

A retrospective case note review of 480 adult patients (>/=18 years) with appendicitis, diagnosed at the Veterans General Hospital-Taipei over a 3-year period, was carried out.

RESULTS

Six patients (1.3% of the adults or 3.9% of the elderly patients), 5 men and 1 woman averaging 71.5 years of age, presented with AUR. Associated existing diseases were benign prostatic hyperplasia in 2 of the males and surgical repair for uterine prolapse in the only female. The mean duration from initial gastrointestinal symptoms to AUR was 1.7 days. The quantity of residual urine ranged from 180 to 450 ml. All patients had persistent right lower quadrant tenderness and hematuria. Five (83.3%) were found to have a perforated appendix at operation, and their average hospital stay was 14.7 (8-29) days.

CONCLUSIONS

AUR may occur as an initial presentation in acute complicated appendicitis in the elderly. It has been reported that the prolonged hospital stay might be related to the delayed diagnosis and resulting complications arising in these patients. Primary care physicians need to be reminded that this common genitourinary complaint may arise in patients with acute appendicitis. When confronted with a geriatric patient presenting with AUR, one should entertain an alternative diagnosis and a reexamination of the patient is mandatory.