Abstract
A 68-year-old woman who had histories of diabetes and chronic dysuria was hospitalized at the department of orthopedics in our hospital for lumber spinal canal stenosis and syringomyelia in August 2010. In the same month, she developed epigastralgia during hospitalization. Close exploration was performed and an abdominal CT scan disclosed ascites and free air in the abdominal cavity. Moreover bubbles of gas in the wall of the bladder and emphysematous cystitis were identified. Laparotomy was performed with a suspected diagnosis of emphysematous cystitis and perforated peritonitis. However, no perforation was found in the urinary bladder, though crackling sensation was slightly felt. No perforated sites were also seen in the abdominal cavity including gastrointestinal tracts. Intraperitoneal lavage and drainage were carried out and the operation was terminated. The patient's postoperative course was uneventful and another abdominal CT scan confirmed improved findings compared with preoperative ones.
A total of 60 cases of emphysematous cystitis have been reported in Japan, and the disease causing peritonitis has been reported in only three cases. However, no cases of the disease with peritonitis without being associated with perforation or rupture of the urinary bladder, like our case, have been reported so far. It is considered to be an extremely rare pathologic condition so that this case is presented here, together with some bibliographical comments.
