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Practice

Emphysematous cystitis

Philippe Leclercq, Michel Hanssen, Philippe Borgoens, Pierre-Julien Bruyère and Patrizio Lancellotti
CMAJ March 25, 2008 178 (7) 836; DOI: https://doi.org/10.1503/cmaj.070524
Philippe Leclercq MD
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Michel Hanssen MD
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Philippe Borgoens MD
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Pierre-Julien Bruyère MD
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Patrizio Lancellotti MD PhD
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  • © 2008 Canadian Medical Association

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Computed tomography scan of the abdomen of a 77-year-old woman without diabetes who was admitted to hospital because of hyperthermia, abdominal pain and confusion.

A 77-year-old woman without diabetes was admitted to hospital because of confusion, hyperthermia and abdominal pain, which rapidly progressed to septic shock. A computed tomography scan of her abdomen demonstrated a thickened, trabeculated bladder wall containing pockets of gas (Figure 1). Cultures of her urine grew more than 1 × 106 colonies of Escherichia coli. Despite intravenous antibiotics and bladder catheterization, the patient died a few days after admission.

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Figure 1: Computed tomography scan of the abdomen of a 77-year-old woman, showing a thickened bladder wall containing pockets of gas (arrows).

Emphysematous cystitis, first identified in 1882 by Keyes,1 is a rare condition that is characterized by gas collections inside the bladder wall. The clinical presentation of emphysematous cystitis is nonspecific and ranges from asymptomatic urinary tract infection to septic shock, as in our patient's case. It is thought that the gas collections are carbon dioxide produced by the fermentation of glucose or albumin by micro-organisms infecting the bladder. The most common causative organisms are E. coli, Enterobacter aerogenes and Klebsiella pneumoniae. Fifty percent of cases of emphysematous cystitis occur in patients with diabetes. Alcoholism, undernourishment and poor health are all risk factors.2 About 1 in 10 patients who receive diagnoses of emphysematous cystitis will die from the condition. Conventional radiography and ultrasonography are often the initial imaging methods used to evaluate patients with abdominal pain. Nevertheless, computed tomography is considered to be the preferred method because of its high sensitivity and specificity in the detection of abnormal gas and its anatomic extension.3

Footnotes

  • This article has been peer reviewed.

    Competing interests: None declared.

REFERENCES

  1. 1.↵
    Keyes EL. Pneumo-uria. Med News 1882;41:675-8.
    OpenUrl
  2. 2.↵
    Grupper M, Kravtsov A, Potasman I. Emphysematous cystitis — illustrative case report and review of the literature. Medicine 2007;86:47-53.
    OpenUrlCrossRefPubMed
  3. 3.↵
    Grayson DE, Abbott RM, Levy AD, et al. Emphysematous infections of the abdomen and pelvis: a pictorial review. Radiographics 2002;22:543-61.
    OpenUrlPubMed
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Canadian Medical Association Journal: 178 (7)
CMAJ
Vol. 178, Issue 7
25 Mar 2008
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Emphysematous cystitis
Philippe Leclercq, Michel Hanssen, Philippe Borgoens, Pierre-Julien Bruyère, Patrizio Lancellotti
CMAJ Mar 2008, 178 (7) 836; DOI: 10.1503/cmaj.070524

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Emphysematous cystitis
Philippe Leclercq, Michel Hanssen, Philippe Borgoens, Pierre-Julien Bruyère, Patrizio Lancellotti
CMAJ Mar 2008, 178 (7) 836; DOI: 10.1503/cmaj.070524
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