Prognostic study, level II-1 (retrospective study). See Guidelines for Authors for a complete description of levels of evidence.

No abstract

Purple discolouration of urine is not commonly encountered in accident and emergency departments. We report a case of an elderly gentleman on long-term urinary catheter who presented with purple discolouration of urine. He was found to have urinary tract infection caused by the bacteria Proteus mirabilis. The urine became clear after urinary catheter change and antibiotic treatment. This is called the purple urine bag syndrome and emergency physicians should be aware of this uncommon condition and the associated potentially dangerous conditions in order to initiate appropriate management. (Hong Kong j.emerg.med. 2009;16:159-160) Keywords: Indwelling catheters, purple urine bag syndrome, urinary catheterization, urinary tract infections CaseAn 81-year-old gentleman presented to our Accident and Emergency Department in October 2008 with a complaint of discoloured urine for one day. He had history of hypertension, ischaemic heart disease and stroke requiring long-term urinary catheterization. He had no fever, urinary tract symptoms nor a history of recent trauma. There was no blood clot noted in the drained urine and he was asymptomatic except for the discoloured urine. His blood pressure was 179/78 mmHg and his pulse rate was 58 beats per minute. He was afebrile and not in respiratory distress. The most striking feature was that the drained urine was purple in colour and the urine bag seemed stained purple too (Figure 1). No blood clot was seen inside the tubing or the urinary bag. He had only been put on his usual medications (lisinopril, methyldopa and simvastatin) for stroke and hypertension. He had not taken other medications or Chinese herbal medicine lately. A urine culture was saved and he was treated as urinary tract infection. The urinary catheter and drainage bag were changed and he was given a course of cefuroxime sodium (Zinnat). The urine culture showed greater than 10 5 colony-forming units per millilitre of Proteus mirabilis. The urine discolouration resolved soon after treatment of the urinary tract infection and he recovered well.

Appendicitis is one of the most common acute abdominal conditions encountered in the Emergency Department. It is a surgical condition that can affect any person of any age and often with varying clinical presentations. In the majority of cases, the diagnosis is straightforward. However in some, the diagnosis requires a heightened clinical suspicion. The application of adjuvant laboratory tests and diagnostic imaging helps to reduce the associated complications, morbidity and mortality of delayed diagnosis.

Benign intratesticular lesions such as epidermoid cyst are rare, but recognition is important to avoid unnecessary surgical intervention (orchiectomy). The combination of ultrasonographic findings and negative tumour markers can help differentiate benign from malignant intratesticular lesions. At surgery, the lesion can be enucleated and frozen sections obtained to confirm the diagnosis, thus avoiding the need for orchiectomy.