ABSTRACT
To present the outcome of percutaneous drainage in cases of emphysematous pyelonephritis [EPN] and feasibility of avoiding nephrectomy in such patients with poor general condition. EPN was diagnosed in seventeen patients by computerized tomography [CT]. All patients received intravenous fluids and antibiotics. Emergency nephrectomy was carried out in two patients. Three patients died before any surgical intervention due to cerebrovascular stroke, uremia and diabetic coma. Percutaneous drainage was carried out for the remaining 12 patients. Kidney could be saved in 3 and subsequent nephrectomy was done in 9 patients. Two patients who underwent emergency nephrectomy survived. Of the evaluable 12 patients [10 diabetic and 2 nondiabetic]; percutaneous drainage was carried out. Resolution of inflammatory process was found in 3 cases and kidney recovered and preserved. Percutaneous drainage was unsuccessful in 9 patients; thus, secondary nephrectomy was necessary but in a better general condition of the patients. The pathogenic organism was Escherichia coli in 9, klebsiella pneumoniae in 2 and proteus mirabilis in 1. Percutaneous drainage may be considered as an alternative to immediate nephrectomy in emphysematous pyelonephritis. It could be the only treatment required and the affected kidney could be preserved. On the other hand when nephrectomy is inevitable percutaneous drainage can delay it until the general condition of the patient becomes better and the technical difficulties become minimal