Severe sepsis secondary to emphysematous cystitis

Abstract

Emphysematous cystitis (EC) is a rare, rapidly progressive infection characterized by gas formation within the bladder wall. Gas production is mainly due to fermentation of glucose or albumin by the pathogenic organisms. We present the case of a patient with EC who presented with severe sepsis of unknown origin. He was also found to have two vesical calculi and a horseshoe kidney. EC was diagnosed on ultrasonography which showed circumferential, acoustic shadowing around the bladder wall. Computed tomography (CT) confirmed the diagnosis. Rapid healing could be achieved with appropriate antibiotics and bladder drainage. Endoscopic disintegration of the stones was performed three weeks later, and follow-up was uneventful.

Emphysematous Cystitis: Report of Two Cases and Review of the Literature

“…The fever is inconstant [30], it is often moderate. Severe sepsis with deterioration of general condition and late-onset disturbance of consciousness sometimes lead to the diagnosis [19] [31] [32]. Abdominal pain is the most common clinical manifestation, reported in 80% of cases [6] [7].…”

<p>Emphysematous cystitis: review of current literature, diagnosis and management challenges</p>

“…Patients may be asymptomatic or showing signs associated to their underlying diseases. It should be taken into consideration that EP and peritonitis have been reported as consequences of EC in dogs, cats, and humans,1,7,8,12,16 and in human medicine, a case of severe sepsis secondary to EC has been described 18. Early detection of EC is therefore of utter importance; therefore, greater attention is required on the presence of risk factors for EC.…”

“…Plain conventional abdominal radiography is the most common imaging method for EC detection both in humans and in dogs 1,5,8,17,18. Plain radiography shows a radiolucent line of gas around the bladder wall, separated from the more dorsal rectal gas (Figure 1).…”

“…However, a radiographic classification has not been adopted yet in dogs. Gas accumulation in the urinary tract can be difficult to differentiate from air in overlying loops of bowel by plain radiography, an explanation to its low sensitivity reported in the human literature (33%) 12,18. Moreover, in veterinary medicine, if the patient is emaciated, radiography may not provide adequate morphologic information on the kidneys, making the detection of an emphysematous upper UTI difficult to achieve 12…”

“…Finally, cystoscopy could be evaluated as a different imaging modality for detection of EC; in human medicine, this examination is indicated as useful in revealing the presence of bladder outlet obstruction,1 but some authors report that it is not essential for diagnosis 18…”