Objective

We report an emphysematous cystitis in a diabetic patient complicated by peritonitis.

Observations

A 66-year-old male presented to the emergency with septic shock. Patient’s history: poorly controlled diabetes and prostate adenoma. Clinical examination revealed a surgical abdomen and signs of shock. Blood sugar was 6 g/L. CRP 274 mg/L. The abdomino-pelvic CT scan showed a perforated bladder with emphysema of the bladder wall and endoluminal air bubbles. The patient was transferred to the intensive care unit. Empirical antibiotic therapy was administered. The surgery consisted of a double-DD with peritoneal lavage and bladder closure. Then, treatment adaptation with cefotaxime, flagyl for Klebsiella pneumoniae . Prior to prostatectomy, a urinary catheter was implemented a month in advance in order to relax the detrusor muscles. The patient was transferred to PMR unit for rehabilitation due to both mixed neuropathy (diabetic and resuscitation) and vesico-sphincter disorders.

Discussion/Conclusion

In addition to emphysematous cystitis being rare, combining with cystitis and air in the bladder wall elevates the severeness. Clinical symptoms severeness is stage-dependent. The presence of the pneumaturia should eliminate differential diagnosis of rectovesical fistula. The association of bladder rupture adds to the complication.

It mainly affects older females .

The predisposing factors are diabetes and urinary stasis (neurogenic bladder, chronic urinary retention).

The most common bacteria are Escherichia coli (58%) and K. pneumoniae (21%).

The fermentation of glucose to formic acid during the breathing of bacteria forms carbon dioxide.

The CT scan is the first line of investigation, which shows aeric hypodensities and the extension of the lesions.

Treatment focuses on parenteral antibiotic therapy with surgical intervention.

Despite the 20% mortality rate, outcomes were favorable in most cases.

The underlying cause of emphysematous cystitis and its catastrophic consequences affecting the urinary tract necessitates both of urological follow-up and rehabilitation.