Abstract
We present a rare case of emphysematous cystitis associated with an emphysematous pyelonephritis in a diabetic Arab man who was admitted in a confusional state. A 60-year-old man was admitted to the emergency department with confusion and hypogastric mass. The Clinical examination found comatose patient with a mass in the tympanic hypogastric percussion. The pelvic computed tomography (CT) demonstrated intramural gas in the urinarytract, which suggested a diagnosis of emphysematous cystitis and emphysematous pyelitis. The treatment was based on an antibiotics associated with a bladder drainage and diabetes stabilization. The evolution was uneventful. Every diabetic patient with a urinary tract infection who seems to be severely ill should have an abdominal X-ray as a minimal screening tool to detect emphysematous complications. The rarity and the association with an emphysematous pyelitis, which is rarely reported in the literature, are two remarkable characteristics described in this case report.
Highlights
Emphysematous cystitis (EC) is the presence of intramural gas, with or without luminal gas, within the bladder as a result of a primary infection of the lower urinary tract with a gas-producing organism
We report the case of EC associated with emphysematous pyelitis (EP) in a patient with diabetic tympani on hypogastric dullness
Other predisposing factors include the presence of a post-micturition residue or chronic retention, presence of renal transplantation, renal infarction, systemic lupus, immunodepression due to long-term corticotherapy or immunosuppressors such as cyclophosphamides well-known for their vesical toxicity, the occurrence of postoperative emphysematous cystitis following endoscopic urologic procedures or colic surgery have been reported in the literature [2]
Summary
Emphysematous cystitis (EC) is the presence of intramural gas, with or without luminal gas, within the bladder as a result of a primary infection of the lower urinary tract with a gas-producing organism. We report the case of EC associated with emphysematous pyelitis (EP) in a patient with diabetic tympani on hypogastric dullness. An abdominal pelvic computed tomography (CT) without injection of intravenous contrast showed a vesical globe containing air (Figure 2, Figure 3) and the presence of the sight at the level of the left pyelon (Figure 4) confirming the diagnosis of cystitis and pyelonephritis emphysematous. After a failure of urethral catheterization, the patient underwent a pubic catheterization returning gases and shady urines, drainage of the upper urinary tract was not done because of the lack of the expansion. Urethrocystography retrograde micturition was realized after 3 weeks showing a stenosis of the urethra and the patient underwent an endoscopic uretrotomy
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