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Document Details :
Title: Een 79-jarige vrouw met buikpijn
Author(s): TOUSSAINT N, DE LAET K, WYNDAELE JJ
Journal: Tijdschrift voor Geneeskunde
Volume: 66 Issue: 18 Date: 2010
A 79-year-old female presenting with abdominal pain
We describe the clinical history of a 79-year-old diabetic female patient with a mild form of emphysematous cystitis (EC). This is a rare complication of a lower urinary tract infection, characterized by the presence of air within the bladder wall and lumen. It is caused by various gas forming uropathogens, Escherichia coli being the most prevalent. EC has a variegated clinical spectrum: from asymptomatic to patients presenting with an acute abdomen and sepsis. The most common symptom is abdominal pain without signs of peritonitis. It remains difficult to differentiate EC from an uncomplicated urinary tract infection, though one should be suspicious in diabetics with abdominal pain, especially with poor glycaemia control.
Other predisposing factors are immunosuppression, neurogenic bladder, recent instrumentation of the urinary tract, chronic urinary tract infection and urinary stasis due to bladder outlet obstruction (BOO). Diagnosis is made radiologically with abdominal CT as gold standard. Our patient was successfully treated with intravenous antibiotics and temporary bladder drainage.
Often this conservative management is sufficient, but in patients with necrotizing infections surgery may be needed. Knowledge of this rare entity may lead to early diagnosis and appropriate management with lower mortality rates.