Fever with abdominal pain and diabetes - Is it Emphysematous Pyelonephritis?

Emphysematous pyelonephritis (EPN) is a rare, severe infection of renal parenchyma presenting commonly with fever and flank pain and presence of gas in the renal and/or peri-renal space. EPN can be life threatening if not diagnosed and treated promptly. Air shadows in the renal or peri-renal region on imaging studies of the abdomen are diagnostic features of EPN. However, computed tomography (CT) scan of the abdomen is better than ultrasound for diagnostic classification, prognosis, and treatment options. We treated a young female with uncontrolled type II diabetes mellitus who had severe abdominal and back pain with fever. The CT scan confirmed the diagnosis of EPN. The conservative treatment itself was effective in complete resolution of the disease even though patient had severe type of EPN.

Colonic obstruction secondary to phytobezoar

Large bowel obstruction is common in clinical practice and colorectal malignancy is a common cause. Bezoars are a rare and uncommon cause of large bowel obstruction. It can mimic tumour resulting in unnecessary surgery. Imaging studies can help in diagnosis. Endoscopy can be both diagnostic and therapeutic. We report a case of a 59-year-old Malay lady who presented with three days history of constant lower abdominal pain and bowel obstruction secondary to colonic phytobezoar. She also had ischaemic colitis. The bowel obstruction was successfully managed without any surgical interventions. Our case highlights a rare but interesting cause of large bowel obstruction that was diagnosed with colonoscopy and successfully managed with bowel lavage and enema.