Bladder rupture secondary to emphysematous bladder: A diabetic patient report

Abstract

We report an emphysematous cystitis in a diabetic patient complicated by peritonitis. A 66-year-old male presented to the emergency with septic shock. Patient's history: poorly controlled diabetes and prostate adenoma. Clinical examination revealed a surgical abdomen and signs of shock. Blood sugar was 6 g/L. CRP 274 mg/L. The abdomino-pelvic CT scan showed a perforated bladder with emphysema of the bladder wall and endoluminal air bubbles. The patient was transferred to the intensive care unit. Empirical antibiotic therapy was administered. The surgery consisted of a double-DD with peritoneal lavage and bladder closure. Then, treatment adaptation with cefotaxime, flagyl for Klebsiella pneumoniae . Prior to prostatectomy, a urinary catheter was implemented a month in advance in order to relax the detrusor muscles. The patient was transferred to PMR unit for rehabilitation due to both mixed neuropathy (diabetic and resuscitation) and vesico-sphincter disorders. In addition to emphysematous cystitis being rare, combining with cystitis and air in the bladder wall elevates the severeness. Clinical symptoms severeness is stage-dependent. The presence of the pneumaturia should eliminate differential diagnosis of rectovesical fistula. The association of bladder rupture adds to the complication. It mainly affects older females [1] . The predisposing factors are diabetes and urinary stasis (neurogenic bladder, chronic urinary retention). The most common bacteria are Escherichia coli (58%) and K. pneumoniae (21%). The fermentation of glucose to formic acid during the breathing of bacteria forms carbon dioxide. [2] The CT scan is the first line of investigation, which shows aeric hypodensities and the extension of the lesions. [3] Treatment focuses on parenteral antibiotic therapy with surgical intervention. Despite the 20% mortality rate, outcomes were favorable in most cases. The underlying cause of emphysematous cystitis and its catastrophic consequences affecting the urinary tract necessitates both of urological follow-up and rehabilitation.