A Case of Emphysematous Cystitis that was Difficult to Distinguish from Gastrointestinal Perforation

Abstract

The patient was an 88-year-old woman with dementia who presented with fever, malaise, and abdominal pain. Physical examination revealed a flat and hard abdomen. There was tenderness in the lower abdomen, but this was unclear due to the dementia. Blood tests showed evidence of an inflammatory reaction, and abdominal CT showed free air in the lower abdominal/pelvic cavity. We suspected peritonitis caused by a gastrointestinal perforation and decided to perform diagnostic laparotomy. Laparotomy revealed no stool or leaking stool in the abdominal cavity. Observation from the Treitz ligament up to the rectum revealed no perforation. However, snow-ball crepitation and edematous changes were noted in the bladder wall. Therefore, we diagnosed the patient as having emphysematous cystitis, completed the operation and closed the abdomen. After surgery, the patient was transferred to the urology department, and while urinary catheterization and antibiotic administration improved the signs of infection, the patient died of aspiration pneumonia during the clinical course. We report a case of emphysematous cystitis diagnosed by diagnostic laparotomy that was difficult to distinguish from gastrointestinal perforation.