Emphysematous Cystitis: Report of an Atypical Case

Abstract

We report the atypical case of a nondiabetic 66-year old male with severe abdominal pain and vomiting who was found to have emphysematous cystitis. Of all gas-forming infections of the urinary tract emphysematous cystitis is the most common and the least severe. The major risk factors are diabetes mellitus and urinary tract obstruction. Most frequent causative pathogens are Escherichia coli and Klebsiella pneumoniae. The clinical presentation is nonspecific and ranges from asymptomatic urinary tract infection to urosepsis and septic shock. The diagnosis is made by abdominal imaging. Treatment consists of broad-spectrum antibiotics, bladder drainage, and management of the risk factors. Surgery is reserved for severe cases. Overall mortality rate of emphysematous cystitis is 7%. Immediate diagnosis and treatment is necessary because of the rapid progression to bladder necrosis, emphysematous pyelonephritis, urosepsis, and possibly fatal evolution.

Enterococcus faecium related emphysematous cystitis and bladder rupture

“…2 4 Symptoms include urgency, frequency, nocturia, dysuria, gross haematuria, supra pubic pain, pyuria, nausea and vomiting. Abdominal pain is the most common symptom in immunocompetent people.…”

“…Diagnosis is mostly radiological, due to the non-specific nature of symptoms. 4 Diagnosis is made by plain radiography, ultrasonography, abdominal computed tomography [CT] and cystourethroscopy. 3 CT is used for delineating severity and extent and to rule out fistulae and malignancies.…”

Emphysematous cystitis: An atypical multi-organism presentation

“…6 Most organisms are facultative anaerobic, while anaerobic isolate, multiple organisms, or no organisms are rarely found. 9 This case exhibits an atypical multi-organism microbiology growing both Klebsiella pneumonia and Enterococcus species.…”

Retroneumoperitoneo secundario a cistitis enfisematosa

“…De acuerdo a los hallazgos imagenológicos el diagnóstico diferencial incluye fístu-la vesico-intestinal, vesico-vaginal e instrumentación del tracto urinario bajo (2,4,8) (cuadro 1).…”

“…La cistitis enfisematosa es una complicación poco frecuente de las infecciones del tracto urinario que se caracteriza por la presencia de aire en la pared o lumen vesical, debido a la colonización por microrganismos formadores de gas, siendo los más frecuentes Escherichia coli y Klebsiella pneumoniae (1,2).…”