Emphysematous cystitis with extraperitoneal gas: new insights into pathogenesis via novel CT findings

Pneumomediastinum as a rare complication in an immunosuppressed patient with emphysematous cystitis

“…The disruption of bladder serosa without involvement of mucosal layer results in the leakage of free air bubbles to the perivesical space that can extend to different parts of the body. 4 Previous cases of emphysematous cystitis have been reported with the presence of extraperitoneal free gas in the pelvis, Retzius space, and the femoral canal. [4][5][6] There are no reports in the literature of gas presence in the retroperitoneal subdiaphragmatic space or in the mediastinum as a complication of emphysematous cystitis.…”

“…4 Previous cases of emphysematous cystitis have been reported with the presence of extraperitoneal free gas in the pelvis, Retzius space, and the femoral canal. [4][5][6] There are no reports in the literature of gas presence in the retroperitoneal subdiaphragmatic space or in the mediastinum as a complication of emphysematous cystitis. Extraperitoneal free abdominal gas (originating from the abdomen) can spread anywhere in the abdomen and pelvis through the interconnected subperitoneal space.…”

Emphysematous cystitis with rare findings of subcutaneous emphysema and extraperitoneal pelvic gas: a case report

“…2 Polymicrobial infections have been reported in very few cases. 7 Pathophysiology of intramural and intraluminal gas production is multifactorial. High tissue glucose concentration and impaired tissue perfusion make a hostile environment for emphysematous infections.…”

“…8 These foci of gas can be seen to move dependently with the patient position and referred to as "champagne" or "effervescent" sign. 7 But, none of these investigations were considered in this patient as we were looking for a sinister intra-abdominal pathology.…”

“…This is a very rare finding described only in few case reports. 7 Early medical treatment in 90% of patients reduces mortality and prevent the need for surgical intervention. 2 It includes broad spectrum parenteral antibiotics, immediate bladder drainage, tight glycemic control and treatment of other comorbidities.…”