Emphysematous pyelitis presenting as an acute abdomen in an end-stage renal disease patient treated with peritoneal dialysis

Successful management of bilateral emphysematous pyelonephritis with abscess formation in a chronic hemodialysis patient: a case report

Bilateral emphysematous pyelonephritis (EPN) has seldom been reported in patients on maintenance hemodialysis (HD). Percutaneous catheter drainage (PCD) or nephrectomy is often required in the treatment of bilateral EPN because of its poor response to antimicrobial agents and high mortality rate. We report a patient with bilateral EPN on maintenance HD. An octogenarian man with diabetes mellitus who had previously undergone regular HD for 22 months was admitted to our hospital because of severe inflammation resulting from bilateral EPN. His lesions of EPN had resulted in abscess formation in both kidneys and right and left side retroperitoneal space. As patient refused interventional therapy including nephrectomy or PCD, he was treated conservatively. After treatment with several antimicrobial agents for 50 days, he completely recovered from bilateral EPN. To our knowledge, this is the first case report of successful conservative management (antimicrobial therapy alone) of bilateral EPN that developed in a chronic diabetic HD patient.

Successful medical treatment of emphysematous pyelonephritis in chronic hemodialysis

Emphysematous pyelonephritis (EPN) is a life-threatening renal infection caused by gas-producing bacteria and fungi. It usually occurs in patients with diabetes and patients with urinary tract obstruction. A combination of systemic antibiotics, percutaneous catheter drainage, or open nephrectomy is typically required to achieve cure. Because of grim prognosis, resorting to interventional methods is frequently inevitable. We report the case of a 77-year-old woman with diabetes and end-stage renal disease on chronic hemodialysis that presented with fever and left flank pain. A bubbly gas pattern inside the left kidney was demonstrated on abdominal computed tomography scan and blood cultures grew Escherichia coli. She was successfully treated solely with systemic antibiotics. This highlights the fact that prompt recognition of imaging findings associated with benign prognosis is essential for a favorable outcome. It allows for an effective management avoiding high-risk interventions, especially in frail patients with multiple comorbidities. Finally, we review all published cases of EPN in chronic dialysis patients.

Emphysematous urinoma as a complication of emphysematous pyelitis in a healthy adult male

Emphysematous pyelitis and urinomas are independently rare conditions. The former is a severe necrotizing infection involving the renal collecting system, the latter an encapsulated collection of urine in the perinephric or paraureteral space. An unusual case of emphysematous urinoma complicating emphysematous pyelitis in a healthy male adult is presented in this study.

Successful treatment of bilateral emphysematous pyelonephritis in a uremic patient without nephrectomy

Emphysematous pyelonephritis (EPN) is a severe and complicated renal infection characterized by gas formation within the infected kidney and its surrounding tissues. Early diagnosis with a high index of suspicion and aggressive treatment are important for improving outcome. Bilateral involvement is rare, and surgical intervention is usually required because of its high mortality rate. A literature review found that EPN has rarely been noted in chronic dialysis patients, and those who show bilateral EPN have demonstrated no survival at all until now. Herein, we presented a 51-year-old diabetic uremic woman who developed right emphysematous pyelitis initially and then progressed to bilateral EPN when hospitalized. Percutaneous drainage (PCD) with simultaneous antibiotic therapy successfully eradicated her renal infection. In this study, all reported cases of EPN in chronic dialysis patients were also reviewed.

[Emphysematous pyelonephritis of single kidney: review of literature about one case]

INTRODUCTION

Emphysematous pyelonephritis is a rare and severe form of acute pyelonephritis. It is defined as the presence of gas-producing bacteria in the kidney and in peri-nepheretic areas. We report a case of emphysematous pyelonephritis on a single kidney associated with urolithiasis.

OBSERVATION

A 44-year-old woman, with a history of diabetes and chronic renal failure, presented with left renal colic, anuria, fever and worsening of general state. The diagnosis of emphysematous pyelonephritis was confirmed by CT scan. The treatment was based on antibiotheray, adapted to the renal function, insulinotherapy and urine drainage by a double J stent. The evolution was favourable.

DISCUSSION

Emphysematous pyelonephritis is an uncommon infection, generally affecting female diabetic patients. CT scan is mandatory to confirm diagnosis.

CONCLUSION

Even if it is rare, emphysematous pyelonephritis is associated with a high mortality in the absence of a rapid and effective treatment.

Pyélonéphrite emphysémateuse : diagnostic et traitement

Emphysematous pyelonephritis is a necrotizing kidney infection characterized by the presence of gas in renal parenchyma, collecting system or perinephric tissue. This rare affection occurs almost exclusively in patients with diabetes mellitus and is due to non-anaerobic gas-producing bacteria. This life-threatening condition leads to septic shock and multiple organ failure. Diagnosis is suspected when a pyelonephritis does not respond to correct treatment, especially with altered vital signs or a diabetic patient. Computed tomography scan permits visualization of the gas and a radiologic classification with a prognostic value. Current treatment modalities are based upon repeated clinical and scanographic evaluations. In addition to systematic antibiotic therapy, percutaneous drainage is probably the first therapeutic stage in the majority of cases, but should not delay emergent rescue nephrectomy if necessary.

[Diagnostic and therapeutic management of acute abdomen in Hajah, Yemen]

We report on the results of surgical treatment in 236 patients admitted with clinical signs of acute abdomen between the 1st of January 2000 and the 31st of December 2003 at the District Hospital of Hajah in northwest Yemen. Hajah, a city 2500 m above sea level, has 60,000 inhabitants and serves an area with 800,000 inhabitants. The hospital was funded by the Saudi Arabian government and built in 1997. Data on patients with acute abdominal pain were prospectively collected and analysed according to diagnosis, age, sex, and duration of symptoms. The most frequent cause was acute appendicitis, followed by incarcerated inguinal hernia. Complicated ulcer diseases of the upper gastrointestinal tract and gynaecological disorders were also frequently diagnosed. Gunshot wounds were the most frequent trauma. Despite the limited diagnostic equipment at the Hajah District Hospital and the short duration of hospital stay, there was no fatal event during the 1-year period analysed. The management of patients with acute abdominal pain and the ability to arrive at exact diagnosis is dependent on the availability of diagnostic means such as abdominal ultrasound and CT scan. However, especially in rural countries with only rudimentary technology, far more depends on the professional training and qualification of the surgeons responsible.