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Patient Details

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Indication / Findings

IMPRESSION (in bold red)

Over filled bladder with volume of 600–700 cc likely Acute Urinary Retention … Patient may need catheterization.

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Key Clinical Points at a Glance

• Patient is post-cholecystectomy (no gallbladder) and post-hysterectomy (no uterus).
• CBD is mildly dilated at 11 mm — expected after cholecystectomy.
• Main finding: Acute Urinary Retention — bladder distended to 600–700 cc, catheterization recommended.
• Both kidneys, spleen, pancreas, liver, bowel, and adnexa are otherwise unremarkable.

Clinical Interpretation — USG Abdomen & Pelvis (Female)

1. Liver — Normal

• Size 14.2 cm is within normal range (up to ~15 cm).
• Normal echotexture, no focal space-occupying lesion (SOL) — no cysts, tumors, or abscesses.
• Intrahepatic bile radicals (IHBR) not dilated — no biliary obstruction upstream.
• Portal vein 10.4 mm — normal (upper limit ~13 mm).

No liver pathology.

2. Gallbladder — Not Visualized (Post-Cholecystectomy)

• The gallbladder has been surgically removed previously. This is a normal expected finding, not a new abnormality.

3. Common Bile Duct (CBD) — 11 mm (Mildly Dilated)

• Normal CBD diameter is <6 mm in non-operated patients and up to ~10 mm after cholecystectomy.
• At 11 mm, this is mildly dilated but expected in a post-cholecystectomy state (the CBD compensatorily dilates after gallbladder removal — called post-cholecystectomy CBD dilatation).
• Smooth distal tapering rules out a distal obstructive cause like a stone or mass.

Clinically not alarming given the surgical history, but should be monitored.

4. Pancreas — Normal

• Normal size and echotexture.
• Main pancreatic duct (MPD) not dilated — rules out chronic pancreatitis or obstructive pathology.
• No sonographic pancreatitis signs.

No pancreatic pathology.

5. Spleen — Normal

• 11.5 cm — within normal range (upper limit ~12 cm).
• No focal lesion.

No splenic pathology.

6. Kidneys — Normal Bilaterally

• Right kidney: 90 × 40 mm | Left kidney: 96 × 49 mm — both normal in size.
• CMD (corticomedullary differentiation) maintained — kidneys are functioning structurally.
• No calculus (kidney stones) or hydronephrosis (no obstruction).

Both kidneys are healthy.

7. Urinary Bladder — ⚠️ CRITICAL FINDING

• Overfilled at 600–700 cc — a normal voided bladder holds ~400–500 cc; this volume indicates the patient has not been able to urinate.
• Wall thickness normal and no mass/stone — so the problem is functional/obstructive, not structural.
• Diagnosis: Acute Urinary Retention (AUR)

In women, AUR is uncommon. The most common causes in females include gynecologic surgery (she is post-hysterectomy), pelvic prolapse, neurogenic dysfunction, or medications. — Tintinalli's Emergency Medicine

Immediate catheterization is required to relieve the obstruction and prevent detrusor damage and upper urinary tract complications. The report explicitly recommends this.

8. Uterus — Post-Hysterectomy

• The uterus has been surgically removed. No abnormality to report.

9. Adnexa — Normal

• No masses in the ovarian/fallopian tube region.
• Pouch of Douglas (POD): No free fluid — no ascites, bleeding, or pelvic collection.

10. Bowel & Peritoneum — Normal

• No free fluid, no lymphadenopathy.
• Gut loops, terminal ileum, and ileo-caecal (IC) junction unremarkable — no bowel obstruction or inflammatory bowel disease signs.

Summary & Clinical Priority

What Should Happen Next

1. Immediate urethral catheterization to drain the bladder and relieve discomfort/pressure.
2. After drainage, a trial of voiding should be attempted — if the patient fails again, clean intermittent self-catheterization (CISC) or short-term indwelling catheter is considered.
3. Urological referral for urodynamic studies if no obvious reversible cause is found.
4. Review any medications (anticholinergics, antihistamines, opioids) that may have precipitated retention.
5. CBD dilatation: if the patient has any right upper quadrant symptoms or elevated liver enzymes, MRCP (MRI of the bile duct) should be considered to rule out a retained stone.