WOFAPS 2025 8th World Congress of Pediatric Surgery

Liying Sun, Leek Mei Lim

Children's Hospital Zhejiang University School of Medicine, Hangzhou, China

Background:
Bladder diverticulum is a rare urological anomaly in children, often asymptomatic or presenting with non-specific urinary symptoms. It is especially uncommon in adolescent females and may mimic other conditions, such as pelvic inflammatory disease (PID), leading to misdiagnosis and delayed treatment.

Case Presentation:
We report the case of a 13-year-old girl with a long-standing history of recurrent hospital visits for urinary-related complaints, including lower abdominal discomfort. She was admitted with fever and persistent suprapubic pain and initially treated empirically for PID, despite the absence of sexual activity. Routine investigations showed elevated inflammatory markers, but pelvic ultrasound and CT scan were unremarkable. After partial symptom improvement on intravenous antibiotics, persistent pelvic pain prompted referral to the paediatric and adolescent gynaecology team. A repeat pelvic ultrasound performed before and after bladder emptying revealed an 8.2 x 4.3 cm cystic lesion posterior to the bladder, which disappeared post-void, consistent with a bladder diverticulum. This finding had been previously missed due to imaging not being timed with bladder filling. The diagnosis was revised, and the patient was referred to urology for further evaluation with CT urogram and cystoscopy.

Conclusion:
This case illustrates how bladder diverticulum may be overlooked in adolescents, particularly when presenting with non-specific pelvic pain. A detailed clinical history of recurrent urinary symptoms and appropriate imaging, ideally with a full and post-void bladder are essential for accurate diagnosis. A multidisciplinary approach ensures timely intervention and avoids mislabeling young patients with inappropriate diagnoses such as PID.