Acute Diffuse Peritonitis Caused by Urinary Retention: A Rare Case of Gangrenous Cystitis

Abstract

Gangrenous cystitis is an umbrella term encompassing conditions from necrosis of the mucosa and submucosa to necrosis of the entire bladder wall that can result in acute peritonitis. Timely diagnosis is challenging as the symptoms are nonspecific and resemble other conditions such as cystitis. We report a case of gangrenous cystitis in a 63-year-old woman who was diagnosed with peritonitis preoperatively by a CT scan of the abdomen. Overdistension of the bladder due to chronic urinary retention was the primary cause. The patient underwent partial cystectomy, excising nonviable detrusor with preservation of the trigone and ureters, but conclusively succumbed. Etiopathology, symptoms, and treatment of this rare disease are also considered.

Gangrenous Cystitis: A Rare Case Report

“…Imaging techniques such as ultrasound, CT, cystography, and cystoscopy contribute crucially to proper diagnosis. Of these, CT is the test of preference, but it is requested only in cases where signs and symptoms of acute abdomen are present [3][4][5]8]. In the present case, an emergent CT scan was performed.…”

“…If the disease is caused by an anaerobic infection or the patient is unstable, surgical treatment should be immediate, and surgical debridement of necrotic tissue and drainage is the appropriate approach. The lifesaving treatment is radical cystectomy, but partial cystectomy may also be performed if the trigonum remains unaffected by the severe infection [1,3,5,6,8]. The initial surgical approach in our case was extensive debridement of necrotic tissue of the abdominal muscles, peritoneum, and bladder and surrounding tissues.…”

“…When necrosis involves the entire bladder wall, it may lead to spontaneous rupture and acute peritonitis [4]. The prognosis remains poor, and the reported mortality is approximately 35% [5].…”

“…The symptoms are nonspecific, making the diagnosis extremely challenging. Typically, it may present with lower abdominal pain, dysuria, pyuria, hematuria, and urosepsis [1,[3][4][5]7]. In delayed diagnosis, it may be considered as acute abdomen, resulting in a poor prognosis [5].…”

Peritonitis aguda secundaria a cistitis gangrenosa posparto

“…La cistitis gangrenosa es una afección infecciosa sumamente rara, con solo 33 casos reportados en los últimos 75 años, pero potencialmente mortal (1) . Su severidad varía desde necrosis de mucosa -submucosa hasta necrosis de toda la pared vesical (2,3) . La etiología es multifactorial y la sintomatología es inespecífica, lo cual la convierte indistinguible de otras afecciones urológicas comunes, por lo que el diagnóstico preciso puede ser difícil y generalmente es realizado cuando existen manifestaciones de peritonitis aguda.…”