Percutaneous drainage in emphysematous pyelonephritis — an alternative to major surgery

Emphysematous Pyelonephritis

“…Impaired tissue perfusion has been speculated as a risk factor and a poor prognostic factor for EPN. 12,17 However, we do not have sufficient evidence to support this speculation owing to limited pathological reports. The pathological findings revealed the evidence of impaired tissue perfusion (ie, infarction or vascular thrombosis) in most patients with class 3 or 4 EPN, but not in the only patient with class 2 EPN.…”

“…However, successful treatment of EPN using percutaneous catheter drainage (PCD) and antibiotic treatment has also been reported. [3][4][5][11][12][13][14][15] Therefore, the adequate therapeutic modalities for EPN are still controversial. Emphysematous pyelonephritis has been classified according to the location of gas accumulation because of various outcomes.…”

Bilateral emphysematous pyelonephritis resolving to medical therapy: demonstration by US and CT

“…The clinical diagnosis of EPN may be difficult as the symptoms are usually non-specific, including fever, nausea, general malaise, confusion, flank pain and dysuria [1][2][3]7]. The majority of patients have no focal physical findings; a few have costovertebral-angle tenderness [2].…”

“…Klebsiella pneumoniae, Proteus mirabilis, Citrobacter, Enterobacter and Candida are less frequently isolated [1,3,6]. In up to 20 % of patients, cultures grow more than one organism.The clinical diagnosis of EPN may be difficult as the symptoms are usually non-specific, including fever, nausea, general malaise, confusion, flank pain and dysuria [1][2][3]7]. The majority of patients have no focal physical findings; a few have costovertebral-angle tenderness [2].…”

Emphysematous Pyelonephritis, Ureteritis, and Cystitis in a Diabetic Patient

“…Pathological findings of the upper ureteral wall removed en bloc with the devas tated kidney supported the diagnosis of emphysematous ureteritis. No histological or endoscopical information was available, but intravesical gas found on CT accompa nied by vesical irritative symptoms was considered to be an indication of emphysematous cystitis [11], Definitive guidelines for optimal management of this condition have yet to be established [4,12], Percutaneous drainage is recommended in some cases as an alternative to major surgery [13], but such treatment in the present case failed to provide satisfactory results since the multi ple cavities of abscess in the involved kidney, though together, were not continuous. Vigorous nonsurgical ther apy is recommended in some cases to be followed by early surgical intervention in mind, should such an approach fail [12,14].…”