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1998 Presentations for the Poster and Vignette Sessions
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EMPHYSEMATOUS CYSTITIS: A Case Presentation. James Kleczka, MD, Geoffrey Lamb, MD. Medical College of Wisconsin.

Emphysematous cystitis is an inflammatory condition of the bladder associated with gas, produced by organisms, in the bladder wall or lumen. Approximately 185 cases have been reported in the literature since Eisenlohr first described this clinical entity in 1888. Emphysematous cystitis is seen most commonly in diabetics and patients with neurogenic bladder or bladder outlet obstruction. The most common pathogens are gram negative rods such as E. Coli, Klebsiella species, and Proteus. The pathophysiology of this disorder involves fermentation of glucose within the bladder wall or lumen to form carbon dioxide gas. In most cases, emphysematous cystitis has a rather benign course and resolves rapidly with treatment of the underlying disorder and appropriated antibiotics.

Case Presentation: The patient is an 80­year­old Hispanic female with a five­day history of diffuse abdominal and flank pain. Fevers, chills and dysuria accompanied these symptoms. She has a past medical history significant for diabetes mellitus. On physical exam she was dehydrated and hypotensive with leukocytosis, hyperglycemia, and a positive urine screen. A KUB revealed air within the bladder wall that was confirmed by CT and the diagnosis of emphysematous cystitis with urosepsis was made. She promptly responded to fluids, antibiotics, and correction of her hyperglycemia. E. Coli grew out of both urine and blood cultures. Follow­up KUB revealed resolution of the air within the bladder wall.

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