Different manifestation of a familiar diagnosis: From anuria to acute appendicitis.

The differential diagnosis of anuria in emergency department (ED) is broad. Secondary to intraabdominal mass pressure or infections, symptoms of micturation difficulties or disuria accompanying to back pain may arise with the interruption of sacral nerve stimulation. Here, we report a patient who admitted to ED with back pain and anuria and diagnosed acute appendicitis (AA) after advanced investigation despite of not to have any abdominal pain. A 36-year-old man admitted to our ED with a 6-h history of back pain and urination difficulty. 750mL of clear urine output was observed after bladder catheterization. Abdominal computerized tomography with intravenous contrast was used and revealed acute appendicitis. The patient consulted with a general surgeon and hospitalized for operation. After the operation, back pain was disappeared, and spontaneous micturition was seen. This case not only represents an uncommon manifestation of AA, but also alerts us to the importance of anatomical considerations when interpreting disease extent with imaging. In the differential diagnosis of back pain and urination difficulty, the rare possibility of AA should be taken into account. Because the presence of unusual findings, such as those associated with the urinary tract or lumbosacral pathologies, may further obscure the diagnosis and delay appropriate therapy.