Synchronous obstructive ureterolithiasis and acute appendicitis

The differential diagnosis of right lower quadrant abdominal pain includes both ureterolithiasis and acute appendicitis. Surgical treatment can be undergone without confirmatory imaging studies after a clinical diagnosis is made. For this reason, an occult, second abdominal process may be present. A 47-year-old male presented with a three-day history of acute right lower quadrant abdominal pain. A contrast CT revealed both a 6 mm calculus obstructing the right ureter and acute appendicitis. The patient underwent appendectomy and ureteroscopy with stent placement at the same time. Simultaneous appendicitis and ureterolithiasis may present with similar clinical findings. Due to the potential risks associated with missing either diagnosis, imaging studies may be an appropriate as a step in the management of the patient with right lower quadrant pain.