A case of emphysematous cystitis caused by mechanical stimulation of pelvic fracture nonunion

Emphysematous cystitis is a rare condition that develops due to tissue hyperglycemia and urinary tract infection by gas-producing bacteria. We report a case of emphysematous cystitis caused by mechanical stimulation of a pelvic fracture nonunion. An 80-year-old man was injured in a motorcycle accident and diagnosed with pelvic fracture. Seven days later, he had high fever and computed tomography (CT) revealed gas in the hematoma around the pelvic fracture and the abscess. Therefore, infection following the pelvic fracture was diagnosed. Despite multiple operations and antibiotics treatment, malformation and nonunion of the pelvis occurred. One month after starting weight bearing, emphysema of the bladder wall adjacent to the pubic fracture were found and spread throughout the bladder wall. With stopping of weight bearing, antibiotics treatment and a urinary catheter, emphysema disappeared after 2 months. It was considered that the pubic fracture fragment irritated the bladder wall due to weight bearing and emphysematous cystitis consequently developed.

Unusual case of emphysematous cystitis mimicking intestinal perforation: A case report

BACKGROUND

Emphysematous cystitis (EC) is a bladder condition commonly caused by gas-generating bacterial infections. Factors that increase the risk for developing this condition include female gender, age ≥ 60 years, and diabetes mellitus, glycosuria, and urinary stasis. The symptoms of EC often lack specificity, making diagnostic imaging techniques crucial for accurate identification of the condition.

CASE SUMMARY

This report presents an unusual case of EC that mimicked intestinal perforation. While it was initially challenging to differentiate between intestinal perforation and EC on admission, the patient managed to avoid unnecessary surgery and made a good recovery solely through antibiotic treatment.

CONCLUSION

Successful treatment of the patient described herein highlights the importance of accurately diagnosing EC, which can be difficult to differentiate from intestinal perforation.

Emphysematous cystitis: A rare and life-threatening condition in patients with uncontrolled diabetes mellitus

Emphysematous cystitis is a rare and potentially life-threatening condition characterized by gas formation within the bladder due to bacterial infection. This article presents a case study of emphysematous cystitis in a 74-year-old male patient with uncontrolled diabetes mellitus and recurrent urinary tract infections. The patient had lower abdominal pain, signs of infection, and urinary symptoms. Imaging revealed bladder wall thickening and gas bubbles. Prompt diagnosis and broad-spectrum antimicrobial therapy were initiated, with intensive care monitoring. After a 14-day treatment, significant improvement occurred, leading to the patient's discharge after 20 days. This case emphasizes early recognition and aggressive management for optimal outcomes.

Gangrene of the anterior abdominal wall secondary to urinary bladder rupture due to emphysematous cystitis: A case report

INTRODUCTION AND IMPORTANCE

Emphysematous cystitis is a rare form of urinary tract infection that can cause the bladder wall to rupture. It is more prevalent in patients with diabetes.

CASE PRESENTATION

We report the case of an 86-year-old man who developed gangrene of the anterior abdominal wall secondary to urinary bladder rupture. We performed a radical cystectomy preceded by an antibiotic treatment.

CLINICAL DISCUSSION

Computed tomography is the key to positive and etiological diagnosis. This is particularly observed among diabetic or immunocompromised patients. Empirical antibiotic therapy and surgical treatment are the major components of management.

CONCLUSION

Management of this rare condition is not standardized but involves surgery in most cases.

Emphysematous cystitis, iliopsoas abscess, and pneumorrhachis in an elderly woman: a case report

BACKGROUND

Emphysematous cystitis is a well-described life threatening complication of urinary tract infection, most commonly seen in patients with diabetes and typically caused by gas forming bacterial or fungal pathogens. Pneumorrhachis is the rare finding of gas within the spinal canal, most commonly reported in the context of cerebrospinal fluid leakage secondary to trauma or spinal instrumentation. To our knowledge there is only one other reported case of pneumorrhachis in the setting of emphysematous cystitis.

CASE PRESENTATION

This is a single case report of pneumorrhachis in the setting of emphysematous cystitis. An 82-year-old Asian female patient originally from East Asia, with no prior medical history besides hypertension, presented to hospital with a chief complaint of acute on chronic neck pain and functional decline. Examination revealed nonspecific neurosensory deficits and suprapubic tenderness. Laboratory investigations demonstrated leukocytosis and extended-spectrum beta-lactamase containing Escherichia coli bacteremia and bacteriuria. Computed tomography showed emphysematous cystitis with widespread gas within the cervical and lumbar spinal canal, as well as multiple gas-containing soft tissue collections in the bilateral psoas muscles and paraspinal soft tissues. Despite prompt antimicrobial therapy the patient passed away within 48 hours from septic shock.

CONCLUSIONS

Our case adds to a growing body of literature showing that the spread of air to distant sites, including the spine, may be a poor prognostic indicator in patients with gangrenous intraabdominal infections. This report highlights the importance of recognizing the causes and presentation of pneumorrhachis to facilitate early diagnosis and treatment of potentially life threatening and treatable causes.

Emphysematous cystitis revealed by necrotizing fasciitis: An unusual presentation

Emphysematous cystitis (EC) is a severe infection of the bladder that usually affects older women with diabetes mellitus. In rare situations, EC can lead to serious complications such as necrotizing fasciitis. We report the case of a 77-year-old woman who developed emphysematous cystitis complicated with rapidly progressive, gas-producing, necrotizing inflammation located on the right lower abdominal wall. The patient had aggressive drainage and debridement in order to control the extensive necrosis. To our knowledge, this is the third case report that describes a possible association between EC and NF requiring aggressive surgical intervention for both diseases.

Emphysematous cystitis: an incidental finding with varying outcomes

Emphysematous cystitis (EC) is a rare severe urinary tract infection characterised by pockets of air in and around the urinary bladder wall caused by gas-forming organisms. Common predisposing factors are chronic infection, immunosuppression, diabetes and neurogenic bladder. The presentation may vary from mild illness to severe life-threatening cystitis. We report two cases of incidental detection of EC diagnosed on imaging for the evaluation of unrelated symptoms. Although asymptomatic, this lethal disease still warrants prompt recognition and treatment with broad-spectrum antibiotics and urinary bladder drainage to prevent severe morbidity and mortality.

Portal vein gas combined with pneumatosis intestinalis and emphysematous cystitis: A case report and literature review

BACKGROUND

Portal venous gas (PVG) is a rare clinical condition usually indicative of severe disorders, including necrotizing enterocolitis, bowel ischemia, or bowel wall rupture/infarction. Pneumatosis intestinalis (PI) is a rare illness characterized by an infiltration of gas into the intestinal wall. Emphysematous cystitis (EC) is relatively rare and characterized by intramural and/or intraluminal bladder gas best depicted by cross-sectional imaging. Our study reports a rare case coexistence of PVG presenting with PI and EC.

CASE SUMMARY

An 86-year-old woman was admitted to the emergency room due to the progressive aggravation of pain because of abdominal fullness and distention, complicated with vomiting and stopping defecation for 4 d. The abdominal computed tomography (CT) plain scan indicated intestinal obstruction with ischemia changes, gas in the portal vein, left renal artery, superior mesenteric artery, superior mesenteric vein, some branch vessels, and bladder pneumatosis with air-fluid levels. Emergency surgery was conducted on the patient. Ischemic necrosis was found in the small intestine approximately 110 cm below the Treitz ligament and in the ileocecal junction and ascending colon canals. This included excision of the necrotic small intestine and right colon, fistulation of the proximal small intestine, and distal closure of the transverse colon. Subsequently, the patient displayed postoperative short bowel syndrome but had a good recovery. She received intravenous fluid infusion and enteral nutrition maintenance every other day after discharge from the community hospital.

CONCLUSION

Emergency surgery should be performed when CT shows signs of PVG with PI and EC along with a clinical situation strongly suggestive of bowel ischemia.

Showering gas bubbles within the inferior vena cava detected sonographically can unmask a hidden infection: a case report of a rare presentation in a patient with emphysematous cystitis

We present a case of incidentally discovered gas bubbles flowing within the inferior vena cava during a routine abdominal sonographic examination, that subsequently unmasked a previously undiagnosed emphysematous cystitis.

Emphysematous cystitis as a potential marker of severe Crohn's disease

Background

Emphysematous cystitis (EC) is characterized by the presence of air within the bladder wall, often a complication of urinary tract infection (UTI) by gas-producing organisms. However, EC has also been reported in the setting of infectious colitis suggesting an alternate etiology. We report a rare case of EC in the setting of severe Crohn’s colitis with no clinical evidence of UTI.

Case presentation

A 43-year old female presented with a 2-month history of bloody diarrhea consisting of 8–12 bowel movements a day, weight loss of 10 kg and peripheral edema. She also had multiple ulcerated lesions on her abdominal wall and in the perianal region. Initial CT scan was significant for pancolitis, anasarca and EC. The follow-up CT cystogram, flexible cystoscopy and pelvic MRI confirmed the diagnosis of EC and ruled out any fistulous tracts in the pelvis including enterovesical/colovesical fistula. The patient did not report any urinary symptoms and the urinalysis was within normal limits. An extensive infectious workup was negative. Despite the paucity of infectious findings, the EC was empirically treated with an intravenous third-generation cephalosporin. Colonoscopy was significant for multiple ulcerated and hyperemic areas with pseudopolyps all throughout the right, transverse and left colon. Biopsies confirmed Crohn’s colitis with no evidence of granulomata or dysplasia. Immunohistochemistry was negative for CMV. The perianal and abdominal wall lesions were suspected to be pyoderma gangrenosum although biopsies were equivocal. The colitis was initially treated with intravenous steroids followed by biologic therapy with Infliximab. Despite appropriate escalation of therapies, the patient developed colonic perforation requiring subtotal colectomy.

Conclusion

This is a rare case of EC in a patient with severe Crohn’s colitis. There was no evidence of urinary tract infection or fistulising disease. According to our review, this is the first reported incident of EC in a patient with inflammatory bowel disease without any prior intra-abdominal surgeries. While active Crohn’s disease alone is a critical illness, we conclude that concomitant EC may be a poor prognostic factor.

Fatal systemic emphysematous infection caused by Klebsiella pneumoniae: A case report

BACKGROUND

Systemic emphysematous infection caused by Klebsiella pneumoniae (K. pneumoniae) is a rare but severe infection which can be lethal if the diagnosis is delayed.

CASE SUMMARY

We report a rare case of systemic emphysematous infection via hematogenous dissemination from a liver abscess caused by K. pneumoniae, complicated by multiple organ dysfunction syndrome, septic shock, bacteremia, emphysematous cystitis, prostate and left seminal vesicle abscesses in a diabetic patient. The patient simultaneously presented with spontaneous pneumoperitoneum secondary to rupture of the emphysematous liver abscess. His condition after admission deteriorated rapidly and he died within a short period. This disease is a great challenge for the clinician as K. pneumoniae can cause multifocal emphysematous infections and fulminant septic shock. Pneumoperitoneum following spontaneous rupture of the liver abscess can result in intra-abdominal sepsis that further increases mortality rate. Moreover, appropriate site-specific intervention and adequate drainage of numerous emphysematous liver lesions are difficult.

CONCLUSION

Early diagnosis followed by efficient antibiotic therapy and surgical management are essential for systemic emphysematous infection.

Emphysematous cystitis due to Streptococcus salivarius infection in a patient with a neurogenic bladder

Streptococcus salivarius (S. salivarius) is an oral commensal bacterium that rarely causes disease. Here, we report a case of emphysematous cystitis due to S. salivarius infection in a patient with a neurogenic bladder. A 56-year-old woman was hospitalized and managed for left putamen hemorrhage. Afterward, she developed poor oral intake. Although the patient was afebrile, laboratory test results suggested an inflammatory response. Urinalysis revealed pyuria and hematuria. Abdominal computed tomography revealed a thickened urinary bladder wall and intraluminal gas. Additionally, she was diagnosed with a neurogenic bladder as she had approximately 200 mL of residual urine. The patient was diagnosed with emphysematous cystitis, and S. salivarius was isolated from urine culture specimens. The patient's condition improved immediately after treatment, which included bladder drainage and administration of appropriate antibiotics. We could not find any report on S. salivarius causing urinary tract infections, such as emphysematous cystitis. Accordingly, we report this case along with a review of the literature.

Emphysematous Cystitis: An Unusual Cause of Septic Shock

Emphysematous cystitis is a rare disease characterized by the presence of gas in the bladder wall and/or cavity. It predominates in diabetic women and its clinical symptoms are varied. We report a case of emphysematous cystitis in an unbalanced diabetic patient, discovered at the stage of septic shock and multivisceral failure following a cardiac decompensation with a rapidly unfavorable evolution. We suggest a probable role of low cardiac output in the genesis of this pathology in some patients.

Emphysematous cystitis: A case report and literature review of 113 cases

Emphysematous cystitis (EC) is a rare complicated urinary tract infection characterized by gas formation within the wall of the urinary bladder. Although EC has multifactorial etiology, commonly seen in elderly, diabetic and female sex; most of the cases of EC present along with emphysematous pyelonephritis (EPN) and full-blown urosepsis. We present a case of EC with EPN presented with features of sepsis managed conservatively. Furthermore, we reviewed the literature of published cases reports of EC with or without EPN from 1999 to 2019 (20 Years). From eligible 113 case reports, data of clinical presentation, demographic profile, risk factors, diagnostic methods, treatment, and prognosis were analyzed.

[Rare emergencies in urology]

INTRODUCTION

The aim of this article was to cite rare but sometimes serious emergencies that may be encountered by any urologist during their practice, and to outline the main principles of their management.

MATERIAL AND METHOD

A systematic review of the literature using PubMed, Embase and Google Scholar was carried out between January 2000 and June 2021. The articles obtained were selected according to their age and type. The original articles, meta-analyses, recommendations and the most recent journal articles published in French and English have been retained. A total of 312 articles were identified and 58 selected from their abstracts. The articles were then analysed exhaustively by the authors, and 24 references were finally selected.

RESULTS

Several rare emergencies of an infectious nature (xanthogranulomatous pyelonephritis, emphysematous cystitis and pyelonephritis, malacoplasia, hydatiduria), ischemic nature (Fournier's gangrene, penile calciphylaxis), or hemorrhagic nature (hemospermia, hemorrhages of the upper urinary tract or adrenal gland spontaneous hematoma), or at the origin of painful manifestations (spermatic colic, venous thrombosis of the penis), can pose diagnostic and therapeutic difficulties, in the absence of consensus concerning their management.

CONCLUSION

These pathologies, rare but sometimes serious, must be recognized in order to not delay the treatment and to be able to reduce their morbidity and mortality. Combined with the constant improvement of our diagnostic and therapeutic arsenal, a better knowledge of these rare emergencies will help to preserve the functional and vital prognosis of patients.

[Emphysematous cystitis and emphysematous pyelonephritis]

Emphysematous cystitis and emphysematous pyelonephritis are rare entities, difficult to diagnose and with high morbidity and mortality. The non-specificity of the medical history and the little usefulness of laboratory tests contribute to diagnostic delay, which increases the possibility of therapeutic failure. We present 2 cases, one of cystitis and another of emphysematous pyelonephritis, who attended the emergency room due to severe urinary sepsis. Despite severity of the symptoms, conservative management was performed with bladder drainage and antibiotic treatment, without interventions or surgeries, presenting a favorable evolution and resolution of the infectious process. Each case must be individualized to offer the best possible therapeutic alternative.

A hyperechoic bladder-ring appearance as pathognomonic finding for emphysematous cystitis - A case report and literature review

An emphysematous cystitis s a rare urinary tract infectious disease and fatal unless any treatments. The case was a 97-year-old female presented with knee pain after falling with co-existence of macroscopic hematuria and pyuria. The ultrasonography examined on the same day showed a hyperechoic bladder-ring appearance bordering bladder wall which was re-was re-confirmed by computed tomography by air bubble collection on the circumferential bladder wall. We conclude and emphasize as the leaning point that emphysematous cystitis is raised as a differential diagnosis when ultrasonography showed the pathognomonic as hyperechoic bladder-ring appearance bordering bladder wall.

Complicated urinary tract infections with diabetes mellitus

Patients with diabetes mellitus (DM) sometimes exhibited impaired immune function and aggravated infectious diseases. Urinary tract infection (UTI) is one of the major complications of DM. A systematic literature search was performed in PubMed and Cochrane Library using the following keywords: diabetes mellitus, urinary tract infection, asymptomatic bacteriuria, emphysematous pyelonephritis, emphysematous cystitis, renal papillary necrosis, and sodium-glucose co-transporter 2 (SGLT2) inhibitors. The treatment of UTI in DM patients is not different from that in non-DM patients, and asymptomatic bacteriuria should not be screened or treated. Emphysematous pyelonephritis is a life-threatening renal infection with gas in the renal parenchyma or perirenal space, and 95% of affected patients had DM. Abdominal computed tomography is useful for diagnosis and determining treatment strategies. Medical management and percutaneous drainage are standard initial treatment, and subsequent nephrectomy for non-responders is considered. Nephrectomy, as an initial treatment, should be limited to a selected group of patients with severe conditions. In contrast, antibiotics, glycemic control, and bladder drainage are adequate treatment for most cases of emphysematous cystitis. SGLT2 inhibitors significantly increased the incidence of genital tract infection, but not that of UTI, pyelonephritis, or urosepsis. Here, we present cumulative evidence about etiology and management for complicated UTI with DM, but there was little information about racial differences and further evidence focusing on Asian population will be needed.

[Emphysematous pyelonephritis and cystitis: An exceptional complication in a kidney transplant recipient]

Emphysematous pyelonephritis is a rare and severe infectious complication characterized by the presence of gas in the renal parenchyma, excretory cavities and surrounded tissues. It is due to the development of non-anaerobic gasifier bacteria. We report a new rare case of emphysematous pyelonephritis in a kidney transplant recipient, particular by its occurrence in a non-functional graft and its exceptional association with emphysematous cystitis.

Emphysematous cystitis - An uncommon yet fatal urinary tract infection

Emphysematous cystitis is an uncommon form of complicated urinary tract infection mostly caused by Gram-negative organisms in elderly, debilitated or immune-compromised patients. It has a varied spectrum of clinical manifestations ranging from asymptomatic to generalised sepsis. Radiological investigations such as conventional abdominal radiography and computed tomography are quintessential for diagnosis. Treatment with culture-specific antibiotics forms the mainstay of management. We present the case of an elderly patient who presented with gastric carcinoma and, during his stay, developed an unexplained fever with rapid clinical deterioration. Emphysematous cystitis was diagnosed radiologically, and urinalysis revealed Klebsiella pneumoniae. Culture-specific antibiotics were started after obtaining the culture report, and despite early and aggressive management, the patient succumbed to generalised septicaemia. Although Emphysematous cystitis is known to have lower mortality compared to other gas-forming infections of the urinary tract, high degrees of clinical suspicion and early management are of paramount importance in obtaining a favourable outcome.

Coexistence of emphysematous cystitis and bilateral emphysematous pyelonephritis: a case report and review of the literature

Emphysematous pyelonephritis (EPN) is a necrotizing infection characterized by the production of gas in the renal parenchyma, collecting system or perirenal tissue. Meanwhile, emphysematous cystitis (EC) is a clinical entity characterized by the presence of gas inside and around the bladder wall. Interestingly, although both diseases are common in patients with diabetes mellitus, these are rarely combined. We report a rare case of a 56-year-old diabetic male suffering from fever, headache and vomiting and in which a diagnosis of septic shock was established due to coexistence of EC and bilateral EPN. The emphysematous diseases improved with a conservative treatment approach using antibiotic therapy and glycemic control, we highlight that the nephrectomy was not necessary in our patient despite the fact that he presented risk factors that predict the failure of conservative treatment.

Incidental discovery of an interstitial emphysematous cystitis with liver abscess: A report of hematogenous spread of infection

Emphysematous cystitis is an unusual urological emergency in clinical practice. The disease characteristics are still underreported. It is characterized by the presence of gas in the urinary bladder wall secondary to gas forming organism. We report an incidental finding of emphysematous cystitis in a 35-year-old secondary to a huge liver abscess in a poorly controlled blood sugar. The infection spread hematogenously to the urinary bladder wall that was managed conservatively by urethral catheter drainage and hepatic abscess drainage in adjunct with antimicrobial therapy. The patient had no urinary symptoms. The bladder wall gas disappeared during follow-up in 2 weeks.

A case of emphysematous cystitis and bladder rupture

This is a case of emphysematous cystitis with a rare complication of bladder rupture requiring surgical intervention in a diabetic man who presented with urinary retention and abdominal pain, with a large amount of intraperitoneal free air on computed tomography scan.

Simultaneous occurrence of hypermucoviscous Klebsiella pneumoniae emphysematous prostatic abscess, emphysematous cystitis, and renal abscess

Emphysematous prostatic abscess is a rare clinical entity of uncomplicated urinary tract infections with high mortality rate. Here we report a case of hypermucoviscous Klebsiella pneumoniae causing emphysematous prostatic abscess, emphysematous cystitis, and renal abscess simultaneously in a 75-year-old Japanese male with diabetes mellitus and advanced gastric cancer. The patient was successfully treated with prolonged intravenous antimicrobial agents.

[Emphysematous cystitis: Report of one case]

INTRODUCTION

Emphysematous cystitis is a rare urinary tract infection characterized by gas in the bladder wall and lumen.

CASE REPORT

We report a 92-year-old women admitted with confusion and abdominal pain without fever. Her past medical history included diabetes, urinary incontinence, high blood pressure and mild cognitive impairment. A computed tomography scan (CT scan) revealed emphysematous cystitis. The patient completely recovered within ten days. The main characteristics and the treatment of this uncommon disorder are presented.

CONCLUSION

Clinicians should be aware of this diagnosis: early management is essential to reduce morbidity and mortality.

Emphysematous Pyelonephritis and Cystitis: Unusual Adverse Events during Concurrent Chemoradiotherapy for Lung Cancer

Various adverse events can occur during antineoplastic therapy. A 67-year-old diabetic woman developed an emphysematous urinary tract infection (UTI) associated with chemoradiotherapy for lung cancer. She had received weekly carboplatin plus paclitaxel with thoracic radiotherapy and developed a fever on day 19. Computed tomography showed a large quantity of gas within the urinary tract. She was therefore diagnosed with emphysematous UTI. Poor diabetes control due to the weekly administration of dexamethasone, an existing urinary tract obstruction, and bone marrow suppression were involved in her serious infection. The potential development of emphysematous UTI during chemoradiotherapy should be considered in at-risk patients.

Enterococcus faecium related emphysematous cystitis and bladder rupture

We describe a 32-year-old lady who was admitted with a urinary tract infection following vacuum-assisted delivery. She was diagnosed with Enterococcus faecium related emphysematous cystitis, bladder gangrene and rupture necessitating emergency laparotomy and partial cystectomy. She had a repeat laparotomy nine days later due to continuing bladder necrosis on cystoscopy. The patient stayed in hospital for over two months due to complications including hospital acquired Klebsiella pneumonia, adult respiratory distress syndrome and malnutrition. Discharge occurred one week after an ileal conduit and ileostomy were performed.

Emphysematous cystitis of the diabetic patient

BACKGROUND

Emphysematous cystitis is defined by the presence of gas in the urinary bladder wall. It complicates urinary tract infections especially in diabetic patients.

AIMS

We present a case of emphysematous cystitis in a diabetic patient with a poor glycemia control and we discuss diagnostics and treatment items of this uncommon and serious infection.

METHODS AND RESULTS

A 45-year-old man was admitted to the emergency department with confusion and abdominal pain. The clinical examination found a septic shock the Ultra-sonography (US) showed a cholecystitis the patient was operated without amelioration. A post operative pelvic computed tomography (CT) demonstrated intramural gas in the urinary bladder, which suggested a diagnosis of emphysematous cystitis. The treatment was based on an antibiotics associated with a bladder drainage. The evolution was in favor.

CONCLUSION

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.