Emphysematous cystitis of the diabetic patient

Affes Nejmeddine1, Bahloul Atef2, Dammak Youssef1, Beyrouti Ramez1, Beyrouti Mohamed Issam1

1Departments of General Surgery, and 2Urologic Surgery
Habib Bourguiba Hospital, Sfax, Tunisia.

Background: Emphysematous cystitis is defined by the presence of gas in the urinary bladder wall. It complicates urinary tract infections especially in diabetic patients. Aim: We present a case of emphysematous cystitis in a diabetic patient with a poor glycemia control and we discuss diagnostics and treatment items of this uncommon and serious infection. Methods and Results: A 45-year-old man was admitted to the emergency department with confusion and abdominal pain. The clinical examination found a septic shock the Ultra-sonography (US) showed a cholecystitis the patient was operated without amelioration. A post operative pelvic computed tomography (CT) demonstrated intramural gas in the urinary bladder, which suggested a diagnosis of emphysematous cystitis. The treatment was based on an antibiotics associated with a bladder drainage. The evolution was in favor. Conclusion: Every diabetic patient with a urinary tract infection who seems to be severely ill should have an abdominal X-ray as a minimal screening tool to detect emphysematous complications. (Nejmeddine A, Atef  B, Youssef  D, Ramez B, Issam BM. Emphysematous cystitis of the diabetic patient. North Am J Med Sci 2009; 1: 114-116).

Keywords: diabetic, urinary tract infection, Emphysematous cystitis, pneumaturia, computed tomography.

Correspondence to: Dr. Affes Nejmeddine, Department of General Surgery, Habib Bourguiba Hospital, Sfax 3003, Tunisia. Tel.: 216 98500014, Fax: 216 74240188. Email: affesnejm@yahoo.fr