Abstract
Emphysematous cystitis is a relatively rear disease among urinary bladder infections, with bacterial gas seen in the bladder wall. A 59-year-old female consulted with a local clinic complaining of generalized edema. Rectum perforation was suspected based on an abdominal computed tomography (CT) scan. Hematological and biochemical examinations detected extreme high hemoglobin A1c (14.3 mg/dL) and WBC (28,060/mm3). Abdominal CT scan showed a diffuse air-pool in her pelvic cavity, but it was uncertain whether the gas was localized air in the urinary bladder or free air in the abdominal cavity. Thus we performed cystoscopy and found cystic changes showing multiple air bubbles in the inside wall of the entire bladder. We could not totally rule out peritonitis because of diabetic neuropathy and the ascites. Therefore, consequently, an exploratory laparotomy was performed, but there was nothing indicating intestinal perforation. Finally, we diagnosed the condition as emphysematous cystitis. We treated the patient conservatively with urinary catheter drainage and antibiotics. She was discharged on the 52nd hospital days. We analyzed 56 cases reported as emphysematous cystitis in Japan, and found no cases in which an exploratory laparotomy was performed. It is important that we should consider emphysematous cystitis for a differential diagnosis when free abdominal air is detected in an emergency ambulatory patient.
