Factores predictivos de mortalidad e ingreso en la unidad de cuidados intensivos en pacientes con pielonefritis enfisematosa: experiencia de 5 años en un hospital terciario

Emphysematous pyelonephritis with rare and severe iliac vascular complications: a case report and review

Emphysematous pyelonephritis (EPN) is a rare but severe necrotizing infection often associated with diabetes, ureteral obstruction, and gas production in the renal parenchyma and perinephric area. This report describes a 54-year-old man with type 2 diabetes who presented with right lumbar pain and was diagnosed with EPN complicated by right ureteral calculi and perinephric gas accumulation. Despite initial improvement with fluid resuscitation, antibiotics, and drainage, inadequate blood glucose control led to a worsening of the infection, eventually involving the psoas major muscle and iliac vessels. This progression resulted in the formation of an iliac aneurysm, which required endovascular surgery. The patient's recovery was supported by proper blood glucose management and targeted antibiotic therapy. This case highlights the importance of early recognition, appropriate management, and strict glycemic control in preventing severe complications of EPN.

Emphysematous pyelonephritis caused by Raoultella ornithinolytica: a case report

BACKGROUND

Emphysematous pyelonephritis is a rare and severe urinary tract infection that is potentially life-threatening and easily progresses to septic shock. In this report, we present a unique case of emphysematous pyelonephritis caused by Raoultella ornithinolytica.

CASE PRESENTATION

An 86-year-old man presented with severe back pain of 3 days' duration. He had a history of hypertension and diabetes for more than 20 years, and his infection indicators and serum creatinine were elevated. Abdominal computed tomography revealed an abnormal gas shadow around his right kidney and the anterior edge of his right psoas muscle. Consequently, he was initially diagnosed with emphysematous pyelonephritis. There was no evidence of nephrolithiasis or other anatomical or structural abnormalities that could have precipitated this focal renal infection. Both blood and drainage fluid cultures revealed R. ornithinolytica. After early anti-infection treatment, percutaneous drainage and moderate control of blood glucose, the patient gradually recovered.

CONCLUSIONS

Emphysematous pyelonephritis caused by R. ornithinolytica is rare but has a high drug resistance rate potentially and may cause severe infections. Early diagnosis, prompt use of antibiotics that are sensitive to the organism, and decompression drainage could be the key to treatment.

Laparoscopic approach for xanthogranulomatous pyelonephritis and pyonephrosis

INTRODUCTION

Xanthogranulomatous pyelonephritis (XGPN) is a rare form of chronic renal inflammation, caused by long-term obstruction of the urinary tract. Pyonephrosis is a severe suppurative complication of acute obstructive pyelonephritis. Although minimally invasive approaches have many advantages, the safe dissection of the kidney may not be always achievable.

MATERIALS AND METHODS

We reviewed 27 cases diagnosed with either XGPN or pyonephrosis, who underwent laparoscopic total nephrectomy between October 2016 and March 2022 in our department. All interventions were performed using the Karl Storz 3D laparoscopic system. The surgical approach was standard transperitoneal nephrectomy for the majority of XGPN, while pyonephrosis cases were carried out in a retroperitoneally. All procedures were performed or supervised by the same surgeon.

RESULTS

The mean operative time was 269.85 minutes (range 145-360). The mean hemoglobin drop after surgery was 1.41 g/dl (range 0.3-2.3 g/dl). Difficult dissection was encountered in 13 cases (48.14%). Nine out of 13 interventions were carried out in a complete intracorporeal fashion, while conversion to open surgery was needed in 4 cases. Vascular complications involving the major blood vessels comprised of one case of inferior vena cava (IVC) tear. Digestive tract-related complications comprised two fistulas of the descending colon and one peritoneal breach. Multiorgan resection was performed in 6 cases.

CONCLUSION

Total nephrectomy in cases of XGPN and pyonephrosis is a challenging procedure. The laparoscopic approach is feasible, as most complications are resolved intracorporeally. However, it may remain reserved for large-volume centers with experienced surgeons.