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Emphysematous Cystitis


Presentation

  • However, as early diagnosis and treatment improve the outcome, a high index of suspicion for unusual presentations is warranted.[ncbi.nlm.nih.gov]
  • Emphysematous cystitis has a highly variable presentation and course, with a considerable potential for complications.[ncbi.nlm.nih.gov]
  • A review of the recent literature is also presented. 2015 BMJ Publishing Group Ltd.[ncbi.nlm.nih.gov]
  • The severity of the illness varies widely from cases diagnosed incidentally to patients presenting with life-threatening sepsis.[ncbi.nlm.nih.gov]
  • Of the three patients, two had to undergo exploratory laparotomy due to their initial presentations with acute abdomens.[ncbi.nlm.nih.gov]
Fulminant Sepsis
  • The clinical course can vary from asymptomatic cystitis to fulminant sepsis. We present a case of a 68-year-old man with emphysematous cystitis with sepsis where early diagnosis and conservative treatment led to a favorable outcome.[ncbi.nlm.nih.gov]
  • The clinical course can vary from asymptomatic infection to fulminant sepsis.[ncbi.nlm.nih.gov]
Hypogastric Mass
  • A 60-year-old man was admitted to the emergency department with confusion and hypogastric mass. The Clinical examination found comatose patient with a mass in the tympanic hypogastric percussion.[ncbi.nlm.nih.gov]
Altered Mental Status
  • A 65-year-old female presented to the Emergency Department with altered mental status, weakness, dark urine, dysuria and fever. She was febrile and lethargic. Abdominal exam showed suprapubic tenderness.[ncbi.nlm.nih.gov]
  • Signs and symptoms of emphysematous cystitis include air in the bladder wall, altered mental status, severe abdominal pain, weakness, dark urine, dysuria, fever, lethargy, vomiting, as well as white blood cells and bacteria in the urine.[en.wikipedia.org]
Spastic Quadriplegia
  • Abstract An 11-year-old female with spastic quadriplegia was seen in the emergency room with abdominal pain, vomiting and anorexia. Labs revealed possible pancreatitis and signs of a urinary tract infection.[ncbi.nlm.nih.gov]
Dysuria
  • We report a case of 52-year-old male who presented with fever, dysuria and gross hematuria who was found to have emphysematous cystitis.[ncbi.nlm.nih.gov]
  • They presented with bladder irritation symptoms such as dysuria, hematuria and frequency. Urinalysis showed pyuria. Cystoscopic examination revealed that bladder mucosa was studded with vesicles varying in size and arranged in clumps.[ncbi.nlm.nih.gov]
  • The patient had no dysuria and there was no evidence of diabetes. The intramural gas collections of the bladder wall, as shown by CT, were compatible with emphysematous cystitis. Urine samples proved infection by a multi-resistant strain of E. coli.[ncbi.nlm.nih.gov]
  • The most important factors involved in this disease are diabetes mellitus, dysuria and neurogenic bladder, with predominance of female gender.We present a case of a 64 years old female patient, with diabetes mellitus tip 2, who presented in our emergency[ncbi.nlm.nih.gov]
  • A 65-year-old female presented to the Emergency Department with altered mental status, weakness, dark urine, dysuria and fever. She was febrile and lethargic. Abdominal exam showed suprapubic tenderness.[ncbi.nlm.nih.gov]
Dark Urine
  • A 65-year-old female presented to the Emergency Department with altered mental status, weakness, dark urine, dysuria and fever. She was febrile and lethargic. Abdominal exam showed suprapubic tenderness.[ncbi.nlm.nih.gov]
  • Signs and symptoms of emphysematous cystitis include air in the bladder wall, altered mental status, severe abdominal pain, weakness, dark urine, dysuria, fever, lethargy, vomiting, as well as white blood cells and bacteria in the urine.[en.wikipedia.org]
Cloudy Urine
  • Urine analysis revealed red, cloudy urine with pH 5.0, nitrite positive and numerous white and red blood cells on microscopy. A pelvic X-ray (figure 1 ) showed circumferential air in the bladder wall.[doi.org]
Foul Smelling Urine
  • The patient's risk factors, marked pyuria, foul smelling urine, and predominant gas collection in the bladder wall make a urinary tract infection most likely. The Final Diagnosis was emphysematous cystitis.[pmj.bmj.com]
Cloudy Urine
  • Urine analysis revealed red, cloudy urine with pH 5.0, nitrite positive and numerous white and red blood cells on microscopy. A pelvic X-ray (figure 1 ) showed circumferential air in the bladder wall.[doi.org]

Workup

Pyuria
  • Urinalysis showed pyuria. Cystoscopic examination revealed that bladder mucosa was studded with vesicles varying in size and arranged in clumps. CT scans of the pelvis showed mottled gas bubbles within the bladder.[ncbi.nlm.nih.gov]
  • Urine analysis may show pyuria, haematuria, bacteriuria, glucosuria or ketonuria. (S. J. Chong K. B. Lim Y. M. Tan* P. K. H. Chow S. K. H.[wikiradiography.net]
  • Urinalysis typically shows bacteriuria, pyuria, and hematuria. [1] Treatment of EC is based on severity.[najms.org]
  • Urinalysis showed combined hematuria and pyuria. Escherichia coli was detected in blood culture.[hindawi.com]
  • Spontaneous bacterial peritonitis must always be considered for this kind of cirrhotic patient as well as the possibility of a urinary tract infection, because of the marked pyuria and multiple risk factors.[pmj.bmj.com]

Treatment

  • CONCLUSIONS: Continuous intravesical irrigation with saline plus amikacin as adjuvant treatment of EC is an inexpensive, effective, and safe tool that might help conventional treatment and provide a rapid recovery.[ncbi.nlm.nih.gov]
  • We describe a patient afflicted with this disorder, outlining the clinical presentation, diagnosis and treatment of the illness. We also emphasize the importance of early detection and appropriate treatment to achieve a favorable clinical outcome.[ncbi.nlm.nih.gov]
  • Abstract Emphysematous cystitis is a somewhat uncommon entity in which early diagnosis and treatment play a key role in avoiding potentially high morbidity and mortality.[ncbi.nlm.nih.gov]
  • A conservative treatment approach using antibiotics and bladder catheterization is typically successful, with a complication rate less than 20%.[ncbi.nlm.nih.gov]
  • Immediate diagnosis and treatment is necessary because of the rapid progression to bladder necrosis, emphysematous pyelonephritis, urosepsis, and possibly fatal evolution.[ncbi.nlm.nih.gov]

Prognosis

  • This is the first study to assess the effect of venous gas on EC prognosis.[ncbi.nlm.nih.gov]
  • Clinical subcutaneous emphysema is a rare complication of EC that appears to have poor prognosis. Only careful clinical judgement, and a high degree of suspicion, will lead to its early diagnosis and treatment.[ncbi.nlm.nih.gov]
  • The prognosis of emphysematous cystitis is good after early diagnosis and prompt treatment with appropriate antibiotics, blood glucose control, and adequate urinary drainage.[ncbi.nlm.nih.gov]
  • Early medical intervention can contribute to achieving a favorable prognosis without the need for surgical intervention. In this review, we provide a comprehensive description of the clinical characteristics of EC.[ncbi.nlm.nih.gov]
  • Clinical subcutaneous emphysema is a rare complication of emphysematous cystitis that has a poor prognosis.[en.wikipedia.org]

Etiology

  • A review of the etiology, pathogenesis, diagnosis and treatment options follows.[ncbi.nlm.nih.gov]
  • Definition / general Rare entity, associated with diabetes, with gas filled cysts in bladder wall Epidemiology Median patient age is 66 years, 64% women, 67% had diabetes mellitus ( BJU Int 2007;100:17 ) Etiology Due to gas forming bacteria ( Clostridium[pathologyoutlines.com]
  • History, physical examination, and imaging can differentiate etiologic causes satisfactorily.[journaldmims.com]
  • Given the patient’s presentation of undifferentiated abdominal pain without clear etiology and her immunocompromised state, a non-contrast computed tomography (CT) scan of the abdomen was ordered.[westjem.com]
  • History, physical exam and imaging are the best modalities to differentiate the above etiologic causes. Fistulous tracts, abscess, can be excluded on CT scan.[doi.org]

Epidemiology

  • Epidemiological, clinical, diagnostic, pathological and therapeutic data were evaluated, including risk factors such as the presence of diabetes mellitus or other comorbid emphysematous infections of the urinary tract.[ncbi.nlm.nih.gov]
  • Definition / general Rare entity, associated with diabetes, with gas filled cysts in bladder wall Epidemiology Median patient age is 66 years, 64% women, 67% had diabetes mellitus ( BJU Int 2007;100:17 ) Etiology Due to gas forming bacteria ( Clostridium[pathologyoutlines.com]
  • Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. 2002;113(1):5–13. Supplement 1. 7. Mokabberi R, Ravakhah K. Emphysematous Urinary Tract Infections: Diagnosis, Treatment and Survival.[westjem.com]
  • We suggest further epidemiological and clinical case series from multiple centres to be evaluated to explore risk factors and clinical outcomes of EC.[omicsonline.org]
Sex distribution
Age distribution

Prevention

  • Prompt diagnosis and treatment are warranted to prevent potential morbidity of and mortality in cases of EC.[ncbi.nlm.nih.gov]
  • Adequate antibiotic therapy, strict blood glucose control, adequate drainage of urine, and early goal-directed therapy for suspected sepsis are suggested to prevent the complications of emphysematous cystitis. Copyright 2011 Elsevier Inc.[ncbi.nlm.nih.gov]
  • Prompt diagnosis and treatment is warranted to prevent the potential morbidity and mortality of this infectious condition.[ncbi.nlm.nih.gov]
  • Awareness of this condition is essential as medical management must be implemented early to prevent a poor outcome. Figure 1 Abdominal X-ray demonstrating thin rim of air within the bladder wall.[casereports.bmj.com]
  • Therefore, prompt diagnosis and treatment are warranted to prevent the potential morbidity and mortality.[hindawi.com]

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