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1998 Presentations for the Poster and Vignette Sessions
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AN ELDERLY MALE WITH DIABETES, NEUROGENIC BLADDER AND ABDOMINAL PAIN. Nasia Safdar, MD. University of Wisconsin Hospital and Clinics, Madison, WI.

A 75 year old male with poorly controlled diabetes, chronic renal failure, hypertension and a prosthetic aortic valve underwent L2-L5 laminectomy for spinal stenosis of 12 years duration. Post-op, anticoagulation was resumed because of his artificial valve. This resulted in the development of an epidural hematoma, which despite early evacuation resulted in a cauda equina syndrome with a neurogenic bladder requiring intermittent catheterization. On the 14th post op day, the patient complained of increasing lower quadrant abdominal pain. Physical exam revealed a temperature of 101 F and diffuse suprapubic tenderness without rebound or guarding. Bowel sounds were present and normal. Stool was guaiac negative. Lab tests were remarkable for the presence of leucocytosis as well as hyperglycemia. Hematuria and glucosuria was present. Plain films of the abdomen showed air in and surrounding the bladder wall. Contrast Imaging was negative for communication with bowel. A diagnosis of emphysematous cystitis was made. Urine culture was positive for >100,000 E. Coli. The patient was treated with Ciprofloxacin for 2 weeks and recovered fully.

Emphysematous cystitis is a rare condition in which pockets of air are formed in and around the bladder wall. 50% of patients are diabetic. Persons with neurogenic bladder are also greatly predisposed to developing this rare disease. Severity ranges from an asymptomatic condition to life threatening cystitis. Treatment requires bladder drainage and antibiotics.

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