An 85-year-old man presented with 5 days of abdominal pain and worsening mental status. On exam, he had a suprapubic mass. Labs showed elevated creatinine. A renal ultrasound found right hydronephrosis. Inserting a Foley catheter drained 2500cc of urine and resolved the mass. He was diagnosed with urinary retention from an enlarged prostate and treated with catheterization, hydration, and medications for his prostate and urinary symptoms.

1. Abdominal Pain: A Case Presentation Erik Manninen, CPT, MC PGY-1 Internal Medicine

2. History CC: Abdominal pain and worsening agitation/mental status x 5 days HPI: 85yo WM with diffuse abd. pain for 5 days, increased urinary frequency, and worsening mentation at night. PMH: BPH and dementia. PSH: ? All: NKDA Meds: Detrol and ambien started one week PTP.

3. Exam VSSAF 8cm diameter suprapubic mass TTP Right CVAT CV: RRR no m/r/g Lungs: CTAB

4. Differential Diagnosis AAA Mesenteric ischemia MI Perforated peptic ulcer Obstruction Pancreatitis Diverticulitis Nephrolithiasis Acute cholecystitis Appendicitis Gastroenteritis Non-ulcer dyspepsia/PUD UTI/Pyelonephritis

5. Labs Cr 3.6 Nl CBC, LFTs Blood cx sent

6. Ancillary EKG with NSR Renal/bladder US with right hydronephrosis and thin renal cortices consistent with CRD

7. Intervention Foley catheter drained 2500cc dark amber colored urine with gross hematuria near end of void with resolution of suprapubic mass. Discontinuance of detrol/ambien. Admission and monitoring of electrolytes along with fluid replacement for post-obstructive diuresis.

8. Outcome Pt.’s Cr improved to 1.8 Pt. Managed by IM with urology consult. Started on proscar (finasteride) and flomax (tamsulosin). MS changes attributed to sundowning, given haldol on cross-cover.