Sepsis from bezoar in the urinary bladder

A 56-year-old male was referred to the emergency department of our hospital with high-grade fever and pain in the lower abdomen. This patient was an immigrant from a Balkan country, of low socioeconomic status, and with no recent history of travel abroad. He used to work on building constructions. No other comorbidities were noted. The patient reported vague abdominal pain, dysuria and low-grade fever, that had begun three months earlier. A urine culture test at that time showed fungus and multiple microorganisms. He received several oral antibiotics without any improvement. The pain gradually became intense but no peritoneal irritation was present during physical examination. A mass at the hypogastrium was palpated. The patient underwent an abdominal ultrasound which described the mass with air, solid and liquid components. Computed tomography of the abdomen better described the mass (Figure 1).