Abstract
Emphysematous urinary tract infections (UTI) are life-threatening conditions caused by gas-forming organisms. Emphysematous pyelitis (EP) is a rare, acute bacterial UTI characterized by gas formation only in the renal collecting system. Extracorporeal shock wave lithotripsy (ESWL) treatment was performed for 10-mm sized stone in the left renal pelvis in an 81-year-old female patient with no known comorbidities other than hypertension. In the 10th hour following ESWL treatment, the patient referred to the emergency department with fever and left flank pain. Gas was noticed in the left renal collecting system in non-contrast computed tomography (NCCT). A wide spectrum antibiotic was given to the patient due to EP diagnosis and a nephrostomy catheter was placed in the left renal pelvis. EP should be considered in the patient with fever and flank pain after ESWL and NCCT should be performed for further examination. Quick diagnosis, examination and treatment of these patients in the emergency department are important.
Highlights
Extracorporeal shock wave lithotripsy (ESWL), commonly used for proximal ureteral and renal stones, is an effective and safe treatment
A wide spectrum antibiotic was given to the patient due to Emphysematous pyelitis (EP) diagnosis and a nephrostomy catheter was placed in the left renal pelvis
EP should be considered in the patient with fever and flank pain after ESWL and non-contrast computed tomography (NCCT) should be performed for further examination
Summary
Extracorporeal shock wave lithotripsy (ESWL), commonly used for proximal ureteral and renal stones, is an effective and safe treatment. A 10-mm sized semi-opaque stone in the left renal pelvis on KUB X-ray (A), in coronal (B) and in transverse cross-sections (C) on NCCT. No complications were detected during the procedure in the patient who underwent the first session of ESWL treatment. In NCCT, a stone in the left kidney renal pelvis and a significant gas image in the pelvicalyceal system were observed (Figure 2). A 10-mm sized stone and gas image in the left renal pelvis, in coronal (A,B), in transverse (C) and in sagittal cross-sections on NCCT ((D). In the urine culture taken from the nephrostomy catheter, multidrug-resistant Escherichia coli was detected; ertapenem treatment was applied by the department of infectious diseases.
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