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Case
Study: Abdominal pain
CC: "Abdominal
pain "
HPI:
48 year old male presents 2 days post lithotripsy complaining
of lower abdominal pain. Patient reports pain started day
before but has been increasing in intensity. Patient describes
pain as dull, colicky in nature, and non-radiating. Patient
reports relief of pain with percocet. Patient also mentions
decreased urinary output and no bowel movement for past
2 days but adds that he hasn't been eating or drinking that
much.
VS: afebrile
PE:
ABD: soft, nondistended, mildly tender to palpation LLQ,
no rebound
or guarding, normal active bowel sounds
BACK: no CVA tenderness
RECTAL: normal tone, heme negative brown stool in rectal
vault
RESULTS:
KUB (view
large image); UA 5 rbc/hpf
ANSWER:
This patient has the radiographic finding
known as Steinstrasse; "stone street." Steinstrasse
is the result of accumulation of multiple stones in the
ureter following extracorporeal shock wave lithotripsy.
Patients can be managed with observation, if they are asymptomatic,
to allow the stones to pass. Patients who are symptomatic
for obstruction or infection require admission for urinary
tract decompression.
Case courtesy of Susan O'Malley, M.D.
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