A Case of Emphysematous Cystitis that was Difficult to Distinguish from Gastrointestinal Perforation

Abstract

This report presents a case of emphysematous cystitis that was difficult to distinguish from a gastrointestinal perforation in an 82-year-old male diabetic patient. This patient was diagnosed as having type 2 diabetes when he came to the hospital for the treatment of a left transcervical fracture. He developed a slight fever of 37 °C and anorexia in the beginning of July, and these symptoms did not improve with over the counter drugs (OTC). He went to the Emergency Room (ER) of this hospital on July 17, because of recurrent vomiting. Abdominal CT revealed excessive accumulation of gas in the small intestine. He was hyperglycemic and had increased plasma CRP. Therefore, he was diagnosed to have a ileus and was hospitalized. The hypogastric pain increased the next day, and abdominal CT showed free gas in the pelvic cavity. Therefore, exploratory laparotomy was performed with a preoperative diagnosis of gastrointestinal perforation. No gastrointestinal perforation was found during surgery, but snow-ball crepitation and edematous change were observed in the bladder wall. A cystoscope test showed submucosal accumulation of bubbles and he was diagnosed to have emphysematous cystitis. Treatment including urethral catheterization, antibiotics and insulin for glycemic control upon fasting resolved the inflammation as well as the images of gas in the bladder wall.