Emphysematous pyelonephritis, a rare cause of pneumoperitoneum: a case report and review of literature

Strofilas, Alexandros; Manouras, Andreas; Lagoudianakis, Emmanuel; Kotzadimitriou, Katerina; Παππάς, Απόστολος; Chrysikos, Ioannis; Menenakos, Evangelos

doi:10.1186/1757-1626-1-91

Cited by 15 publications

(24 citation statements)

References 15 publications

(22 reference statements)

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“…Similar to EPN, EP is also associated with uncontrolled Diabetes Mellitus (DM) and urinary tract obstruction. E.coli, Klebsiella pneumonia and aerobacter are the most common bacteria causing EP [4,7]. In the present case, the causative agent was E coli.…”

Section: Discussionmentioning

confidence: 58%

“…EP has a mortality rate of 20% which is much lower than that of EPN [4,7]. Similar to EPN, EP is also associated with uncontrolled Diabetes Mellitus (DM) and urinary tract obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…On USG, flat anterior margin echoes with dirty shadowing with low level internal echoes and reverberations are seen [7]. According to Alexander et al, ultrasound is insensitive for the diagnosis of renal gas, but useful in diagnosing urinary tract obstruction [6].…”

Section: Discussionmentioning

confidence: 99%

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A Rare Case of Pneumoureter: Emphysematous Pyelitis versus Emphysematous Pyelonephritis

Hiremath¹

2015

JCDR

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A 49-year-old male with no prior medical history presented to the surgical outpatient department with complaints of intermittent fever, radiating pain in the right loin region, dysuria and haematuria since 1 month. On examination, he was stable, afebrile and his vital signs were normal. Per abdomen examination revealed right renal angle tenderness. Examination of other systems was within normal limits. Clinical diagnosis of right ureteric colic with secondary renal infection was made and the patient was referred to the department of radio diagnosis for the purpose of ultrasound abdomen and radiograph Kidney Ureter Bladder.Urine analysis revealed-Pus cells (5-8/hpf), RBCs (7-8cells/hpf) with presence of amorphous phosphate crystals and epithelial cells. Urine culture yielded growth of Eschericia coli (E coli). Renal functional parameters were within normal limits. Fasting blood sugar level was 410 mg/dl and post prandial blood sugar level was 607 mg/dl with high levels of glycosylated Hb (13%). Urine sample was negative for ketone bodies. Leucocytosis was noted in the blood counts.Ultrasound (USG) abdomen and pelvis showed fatty infiltration of liver & features of cystitis. Right kidney was mildly enlarged with moderate to gross hydronephrosis. Multiple hyper echoic foci were noted in the mid and lower poles of the right kidney with mixture of clear and dirty after shadowing-suggestive of presence of both calculus and air in the collecting system [Table/ Fig-1].KUB radiograph revealed presence of a fragmented right staghorn calculus with multiple foci of air in the region of right kidney. A well defined tubular curved air filled structure was noted in the right paravertebral region suggestive of right pneumoureter [Table/ Fig-2].In view of above findings, the patient was immediately shifted for spiral Computed Tomography (CT) KUB plain with 16 slice CT using Siemens Somatom emotion. CT revealed large fragmented staghorn calculus in the right renal pelvis causing gross hydropneumopelvis with thinning of renal parenchyma. Multiple foci of air with large airfluid level were noted in the dilated right pelvis. Right upper and mid ureter was mildly dilated and was filled with air. Perinephric fat stranding was noted. Focus of air with air-urine level was also noted in the urinary bladder [Table /Fig-3]. However, there were no air pockets in the right renal parenchyma or perinephric region. With above findings, diagnosis of right emphysematous pyelitis ABSTRACTEmphysematous pyelitis is a rare benign entity which is defined as isolated gas production in the pelvicalyceal system, ureters or in the urinary bladder as a consequence of acute bacterial renal infection. In this case report we present a case with no prior medical history of diabetes or urinary obstruction who presented with uncontrolled hyperglycaemia for the first time associated with emphysematous pyelonephritis. Further, the imaging differences between emphysematous pyelonephritis (EPN) and emphysematous pyelitis (EP) has been discussed along with the appro...

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Section: Discussionmentioning

confidence: 58%

“…EP has a mortality rate of 20% which is much lower than that of EPN [4,7]. Similar to EPN, EP is also associated with uncontrolled Diabetes Mellitus (DM) and urinary tract obstruction.…”

Section: Discussionmentioning

confidence: 99%

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A Rare Case of Pneumoureter: Emphysematous Pyelitis versus Emphysematous Pyelonephritis

Hiremath¹

2015

JCDR

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“…Higher mortality rates have been observed in patients with adverse prognostic factors such as hyponatraemia, thrombocytopaenia, or renal failure at presentation. 6 Some patients (particularly non-diabetics) may do well with conservative management with percutaneous or open drainage with antibiotic treatment. However, early surgical intervention in the form of a nephrectomy needs to be considered in patients with extensive disease or in those who do not substantially improve after appropriate medical treatment and drainage.…”

Section: Discussionmentioning

confidence: 99%

Emphysematous pyelonephritis masquerading as hollow viscus perforation

Malolan

Shivaswamy

Babu

et al. 2014

African Journal of Emergency Medicine

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Introduction: Emphysematous pyelonephritis (EPN) may be defined as a severe infection of the kidney that leads to necrosis and the presence of gas in the renal parenchyma, surrounding tissue, and the pelvi-calyceal system. EPN occurs almost exclusively in diabetics, but may occasionally complicate obstructive uropathy in nondiabetic patients. Case Report: We present the case of a 45 year old male with uncontrolled diabetes mellitus who presented with acute abdominal pain and free intraperitoneal air on abdominal radiograph, initially suggestive of hollow viscus perforation. He was found to have EPN that had ruptured into the peritoneal cavity. Conclusion: Acute abdominal emergencies presenting with a pneumoperitoneum are not an uncommon occurrence in emergency centres throughout the world. However, rarely, patients present with the source of the pneumoperitoneum being an organ other than bowel. These patients need to be identified as soon as possible to prevent further morbidity and mortality arising from a delay in diagnosis.Introduction: La pye´lone´phrite emphyse´mateuse (PNE) peut se de´finir comme une infection grave du rein, entrainant une ne´crose et la pre´sence de gaz dans le parenchyme re´nal, les tissus pe´rire´naux et le syste`me pelvis-calices re´naux. La PNE survient presque exclusivement chez les personnes diabe´tiques, mais peut parfois entrainer une complication de l'uropathie obstructive chez les patients non diabe´tiques. É tude de cas: Nous pre´sentons dans cet article le cas d'un homme de 45 ans souffrant de diabe`te sucre´non controˆle´consultant pour des douleurs abdominales aigue¨s et la pre´sence d'air libre intra-pe´ritone´al apparaissant a`la radiographie abdominale, sugge´rant dans un premier temps une perforation des visce`res creux. Il souffrait en re´alite´d'une PNE avec rupture dans la cavite´pe´ritone´ale. Conclusion: Les urgences abdominales aigue¨s associe´es a`un pneumope´ritoine ne constituent pas un cas rare dans les centres d'urgences du monde entier. Cependant, il est rare que la source du pneumope´ritoine soit un organe autre que l'intestin chez les patients se pre´sentant. Ces patients doivent eˆtre identifie´s le plus rapidement possible afin d'e´viter une morbidite´et une mortalite´supple´mentaires associe´es a`un retard de diagnostic. African relevanceEmphysematous pyelonephritis is a very rare and late presentation of a common disease. It presents late due to lack of access to healthcare and poor patient education. It is more common in immunocompromised and diabetic patients with greater mortality and morbidity.

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“…Schultz and Klorfein proposed the term "EPN" in 1962. 2,3 Escherichia coli is the most common causative pathogen, however, Klebsiella, Clostridium, Proteus, Pseudomonas, Enterobacter, Citrobacter, Candida, Aspergillus and Cryptococcus were also reported from urine or blood culture of many patients of EPN. Though EPN is mostly unilateral with the left kidney affected more than the right, in approximately 5 to 10% of cases it is bilateral.…”

Section: Introductionmentioning

confidence: 99%

Emphysematous pyelonephritis: a rare case report

2017

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Emphysematous pyelonephritis (EPN) is a rare and life threatening infection of kidney characterized by gas in the renal parenchyma and surrounding tissues. It occurs mostly in patients with diabetes mellitus and has a predilection for females. It is associated with a high mortality in the absence of rapid and effective treatment; therefore, aggressive medical management, early intervention or surgical approach is recommended. Reported here is a case of a 52-year female with previous medical history of diabetes presented with uncontrolled hyperglycaemia, fever and dysuria with right sided flank pain. She was diagnosed with emphysematous pyelonephritis and successfully treated. As emphysematous pyelonephritis is a life-threatening infection, it should always be considered in the differential diagnosis for a patient with fever with abdominal pain or suspected pyelonephritis particularly in a diabetic.

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Emphysematous pyelonephritis, a rare cause of pneumoperitoneum: a case report and review of literature

Abstract: Introduction: Emphysematous pyelonephritis is a gas-producing necrotizing bacterial infection that involves the renal parenchyma and perirenal tissue.

Cited by 15 publications

References 15 publications

A Rare Case of Pneumoureter: Emphysematous Pyelitis versus Emphysematous Pyelonephritis

A Rare Case of Pneumoureter: Emphysematous Pyelitis versus Emphysematous Pyelonephritis

Emphysematous pyelonephritis masquerading as hollow viscus perforation

Emphysematous pyelonephritis: a rare case report

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