This is a case of urethral fish ( candiru fish)
It should be removed either by cystoscopy or surgically.
Candiru fish, is a species of parasitic freshwater catfish in the family Trichomycteridae native to the Amazon Basin where it is found in the countries of Bolivia, Brazil, Colombia, Ecuador and Peru.
Although some candiru species have been known to grow to a size of 40 centimetres (16 in) in length, others are considerably smaller. These smaller species are known for an alleged tendency to invade and parasitise the human urethra; however, despite ethnological reports dating back to the late 19th century, the first documented case of the removal of a candiru from a human urethra did not occur until 1997. a candiru “jumped” from the water into the urethra as the man urinated while thigh-deep in a river.
As the CT scan had shown increased adipose tissue that compressed the bladder and the rectum, the diagnosis of pelvic lipomatosis was made based on the clinical and the radiological findings. Since renal function was unimpaired and symptoms attenuated, the conservative management with close follow up was decided.
- The differential diagnoses : any pelvic mass that compress bladder and the ureters.
- No further investigations is needed.
- Pelvic lipomatosis is the likely diagnosis.
- No treatment should be done. conservative management with close follow up only.
An emergency CT scan was performed which showed a large aneurysm of the right common iliac artery in the Process of rupturing, and a small aneurysm of the left iliac artery. The patient was still haemodynamically stable when he was transferred to the vascular surgery department to undergo immediate surgery. However, he developed multiple complication =s, underwent surgery several times and eventually died in hospital a month later.
When the gas seen in the wall of the bladder, it is emphysematous cystitis. When the gas outlining the collecting system, it is emphysematous pyelitis. This infection is caused by gas forming organism. Renal pelvic gas may be due to reflux of gas after instrumentation. But large amount of gas as we see in the bladder and the left upper calyx, mostly caused by Colovesical fistula due to Diverticulitis, Crohn’s disease and carcinoma of colon.