Emphysematous cystitis (EC) or bladder pneumatosis is a very rare condition characterized by air within the wall of the bladder as a result of infection by gas‐forming organisms. Predisposing factors include diabetes mellitus, a neurogenic bladder, bladder‐outlet obstruction, in‐dwelling urethral catheters and recurrent urinary tract infections The major risk factor is diabetes mellitus (1). There are reported cases in literature of bladder pneumatosis without urinary tract infection (2). The amassing of gas within the wall of the bladder in this cases is not clear, a similar process of intestinal pneumatosis was proposed (2,4). Here we present a case of Bladder pneumatosis in an elderly woman affected by diabetes.
A female patiste 75 years old presented with asthenia, hyporexia cachexia, was affected by lung cancer with metastasis, BPCO and 24 hour oxygen therapy, hearth failure, hyperthyroidism , DM, Bartolini’s gland abscess. The patients presented in acute urinary retention, so an indwelling catheter was placed with drainage of 800 cc of clear urine. A computed contrasted tomography scan of the abdomen and thorax showed the presence of a lung cancer with multiple liver and lymph nodal metastasis and multiple air‐filled cysts within the wall of the bladder.
Work‐up failed to show an infectious etiology, results of the urine analysis did not show pyuria, hematuria or bacteriuria, and no organisms were isolated from urine and blood cultures carried out before the administration of antibiotics. Antibiotic therapy was administered for Bartolini’s gland infection. No therapy was administered ether for lung cancer nor metastasis, the patients was addressed to palliative therapies.
EC is a rare disorder characterized by the amassing of gas in the wall of the bladder. The disease is most common in female than in male (64% vs 36%) and more frequent in middle‐aged diabetic women (mean age 66 years) (3,6,7). There are several theories on the pathogenesis of these gas‐forming infections, but the combination of the presence of gas‐producing organisms, high glucose concentration in tissues and impaired tissue perfusion all favor the development of emphysematous infections of the urinary tract (1). Clinical presentation varies with abdominal pain, outlet irritative symptoms, pneumaturia and acute abdomen are are the most frequent symptoms (3). This is not a typical emphysematous cystitis case. Bladder ischemia could allow bacterial to enter in the bladder wall as happens in intestinal ischemia (5). The most common bacterial etiology are Escherichia coli and Klebsiella pneumoniae (80%) (6). None of the theories proposed to explain EC can fully account for the characteristic features of this case.
Bladder penumatosis is a rare condition not fully understood not always associated to UTI. Il Conservative treatment, urinary tract decompression with indwelling catheter and antibiotic treatment are preferred.
1. M. Amano, T. Shimizu Emphysematous cystitis: a review of the literature. Intern Med, 53 (2014), pp. 79-82.
2. J. Medina-Polo, J.A. Nunez-Sobrino, R. Diaz-Gonzalez An unusual case of air within the bladder wall: bladder pneumatosis? Int J Urol, 18 (2011), pp. 375-377.
3. A.A. Thomas, B.R. Lane, A.Z. Thomas, et al. Emphysematous cystitis: a review of 135 cases. BJU Int, 100 (2007), pp. 17-20.
4. A.J. Aschoff, G. Stuber, B.W. Becker, et al. Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging, 34 (2009), pp. 345-357.
5. P. Renner, K. Kienle, M.H. Dahlke, et al. Intestinal ischemia: current treatment concepts. Langenbecks Arch Surg, 396 (2011), pp. 3-11.
6. E.P. Oñate, M.E. Sanhueza, R. Torres, E. Segovia. Emphysematous cystitis: report of one case. Rev Med Chil. 2014 Jan;142(1):114-7.
7. I.J. Cooke, L.M. Okorji, R.S. Matulewicz, D.T. Oberlin, B.T. Helfand. Bladder Pneumatosis From a Catastrophic Vascular Event. Urol Case Rep. 2016 Aug 4;8:58-60.