A Rare Cause of Acute Urinary Retention in a 7-Month-Old Infant

Introduction:

Gastrointestinal tract duplication cysts are rare congenital malformations that may present with varied and nonspecific symptoms. Presacral masses in infants pose a diagnostic challenge due to their subtle and atypical clinical presentation. Urinary retention as a presenting feature is particularly uncommon.

Case Report:

We report the case of a 7-month-old male infant who presented with constipation and acute intermittent urinary retention. Per-rectal examination revealed a palpable posterior mass with a narrow base, raising suspicion of a presacral or pelvic mass. Ultrasonography of the pelvis demonstrated a well-defined, rounded to oval-shaped cystic lesion located centrally in the lower pelvis, posteriorly.

A contrast-enhanced computed tomography (CT) scan of the abdomen confirmed a cystic pelvic mass anterior to the rectum, producing a mass effect. Magnetic resonance imaging (MRI) of the pelvis was performed to delineate its relationship with the sacral spine. The lesion appeared hyperintense on T2-weighted images, with no evidence of spinal involvement.

Surgical exploration was undertaken, and an intraoperative diagnosis of rectal duplication cyst was confirmed. The postoperative course was uneventful, and the child was discharged on the fourth postoperative day. At follow-up, the patient was asymptomatic and thriving well.

Conclusion:

This case highlights an unusual presentation of rectal duplication cyst manifesting as urinary retention in infancy. A thorough clinical evaluation, including per-rectal examination, is crucial in children presenting with acute urinary retention to exclude presacral or pelvic masses.

Source: J Case Rep Images Pediatr 2024;6(2):1–4.