Emphysematous cystitis is an uncommon condition characterised by the presence of gas in the bladder. It is an infection caused by gas forming organisms, usually in elderly women with a background of diabetes mellitus. The presentation is variable, however with increasing use of imaging more cases are being diagnosed in asymptomatic patients. Routine cross-sectional imaging is not advocated for specific diagnosis but its role in accurate assessment of the severity of the condition cannot be overlooked. As the mode and duration of follow-up in incidentally detected cases has not been addressed in the literature, follow-up should be tailored individually depending upon the severity and response to treatment. We describe two such incidentally detected cases of emphysematous cystitis in elderly diabetic patients and present a review of the literature. The triad of treatment is adequate control of diabetes, antibiotics and bladder drainage. One patient died in the hospital, while the other underwent a flexible cystoscopy 6 weeks later which was normal.

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