1. 20 November 2011 · 08:14 PM · 42 notes

    Case 2# The Not So Common AUR ~ :)

    11 years old malay girl, primary amenorrhea, presented multiple times to casualty for recurrent AUR which relieved after insertion of urinary catheterization. She had advised to be admitted on last presentation for further workup but her father requested AOR (at own risk) discharge in view of work problems. She presented again with acute urinary retention for the past 1/7. This is associated with abdominal pain and distension. Patient otherwise well, no fever, no altered bowel no recent history of fall or trauma.

    O/E; well build,

    Vital sign monitoring shows

    • BP - 110/70
    • PR - 100 Spo2- 100% under RA
    • Pain Score 6/10
    • Lungs : Clear, equal A/E CVS - S1S2 no murmur, no cardiac enlargement or signs of failure noted
    • Abdomen soft, tender at the umbilical and suprapubic regions + Mass palpable at the umbilicus region, unable to palpate the lower border, mild tenderness on palpation
    • PR - Bogginess at the anterior aspect of the rectum. Tender

    US abdomen shows: Enlarged bladder up to the umbilicus CBD was inserted however urine out is only in tubing.

    Repeat bedside ultrasound shoes CBD baloon is “outside” the “bladder”.

    She was then referred to the gynaecology team where vaginal examinations reveal IMPERFORATED HYMEN She was then planned for elective operations in few days.

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