Abstract
A 79-year-old anuric female with diabetic nephropathy, who had undergone maintenance hemodialysis, had a bilateral lower extremity amputation in consequence of severe diabetic neuropathy. She complained of gross hematuria from day 18 after the operation, and then abdominal pain and hypotension developed 2 days later. CT scan showed bladder hypertrophy and gaseous shadow in the lumen. These findings were consistent with a diagnosis of emphysematous cystitis. The urine culture yielded Escherichia coli, and the blood culture contained Bacteroides fragilis. Consequently, we diagnosed the patient with sepsis from emphysematous cystitis caused by these two bacteria. Ureteral catheterization and administration of an antibiotic resulted in marked improvement in the clinical course. There have been few reported cases of dialysis patients with emphysematous cystitis, especially with anuria. It is not known at present why emphysematous cystitis is so rare in dialysis patients. It is possible that it is treated as an infection of unknown origin and improved by empirical therapy. Usually, emphysematous cystitis can be successfully treated with appropriate antibiotics and bladder drainage ; however, a delayed diagnosis can result in a critical condition, such as septic shock. Making an early diagnosis of emphysematous cystitis and providing early treatment are essential to achieving a good prognosis.
