Objectives
To define pre‐morbid, clinical, laboratory, and imaging features and identify prognostic factors associated with morbidity and mortality in patients with emphysematous pyelonephritis (EPN) and develop a prognostic scoring system for improving management outcomes.
Patients and Methods
From January 2009 to December 2019, we performed a prospective study of all patients with a suspected diagnosis of EPN referred to a specialist tertiary centre in South India. All patients who underwent non‐contrast computed tomography of the abdomen and those diagnosed with EPN were included in this study. Demographic parameters, imaging, haematological and microbiology results were recorded. Patients were divided into three groups: Group 1, patients who survived without any intervention; Group 2, those who survived with surgical intervention; and Group 3, those who died with or without intervention. A prognostic scoring system was developed from 18 different parameters and risk stratification was developed. The scores were correlated with overall prognosis.
Results
Data from 131 patients with EPN enrolled in the study were analysed: Group 1 (n = 22), Group 2 (n = 102) and Group 3 (n = 7). By using univariate analysis, 10 factors were identified to be significantly associated with prognosis. Diabetes mellitus was the most common comorbidity. Shock at initial admission indicated a poor prognosis and warranted immediate attention (P < 0.001).
Conclusions
A multi‐disciplinary approach, a high index of clinical suspicion, an early diagnosis and administration of culture‐specific antibiotics with identification of prognostic indicators and risk stratification, allows prompt and appropriate medical and surgical treatments that could improve EPN management outcomes.
Spontaneous rupture of urinary bladder is a rare condition. Most of the bladder ruptures occur in association with blunt or penetrating injuries to the lower abdomen. Most often, a vague lower abdominal pain is the mode of presentation. Rarely patients present with oliguria, anuria, uremia or urosepsis.
A forty year old male, under the influence of alcohol, presented with lower abdominal pain and anuria for two days with abnormal renal function. He denied history of blunt trauma. He was diagnosed to have an intra-peritoneal rupture of urinary bladder. He underwent emergency laparotomy with repair of bladder rupture.
This case report illustrates the need for a high index of clinical suspicion. Prompt diagnosis and appropriate management will help in preventing a poor clinical outcome in patients with spontaneous bladder perforation. If left untreated or if there is a considerable delay in diagnosis and intervention, it usually is associated with a high morbidity.
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