Abstract
A 49-year-old woman with type 2 diabetes mellitus and nonadherence to insulin therapy presented to the emergency department with several weeks of urinary frequency, urinary incontinence, and pneumaturia. Blood laboratory studies revealed severe hyperglycemia. Computed tomography of the abdomen and pelvis (Figures 1 and 2) showed marked distention of the urinary bladder and extensive gas within the bladder wall and lumen, consistent with emphysematous cystitis. Antibiotics were initiated and urinary catheter was placed for decompression. Urine and blood cultures grew multidrug-resistant Escherichia coli. The patient improved with antibiotics and insulin therapy, discharging from hospital 10 days later.Figure 2Midline sagittal view of the patient. Arrows denote intraparenchymal gas of the bladder wall while an asterisk denotes intraluminal gas in the bladder.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Emphysematous cystitis is a potentially life-threatening infection characterized by gas within the bladder wall and lumen due to gas-forming bacteria. Risk factors include diabetes mellitus and urinary stasis with cases occurring more often in women than men. Mainstays of treatment include bladder decompression, antibiotics, and glycemic control, with surgical intervention reserved for cases that fail medical management.
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