Cistitis enfisematosa: una causa poco frecuente de dolor abdominal / Emphysematous cystitis: An uncommon cause of ab dominal pain

Resumen Una mujer de 82 años con antecedentes de hiperten sión arterial e hipotiroidismo acudió al servicio de urgencias por dolor abdominal, diarrea, confusión y deterioro de su estado general de varios días de evolu ción. A su admisión, la paciente se encontraba febril y la analítica mostró una elevación de la proteína C reac tiva sin leucocitosis (8.9 × 10[PRESERVECIRC]9/L). En ese contexto se realizó exudado nasofaríngeo para SARS-CoV-2 que fue negativo. Con estos resultados, la sospecha inicial era la de un cuadro infeccioso de origen digestivo. La muestra de orina era maloliente con presencia de leucocitos y nitritos enviándose a cultivo microbiológico. Se inició tratamiento antibiótico empírico con una cefalosporina de tercera generación ante la sospecha de une posible infección urinaria. Se decidió la realización de una tomografía tóraco-abdomino-pélvica con el objetivo de evaluar la presencia de otros focos infecciosos en una paciente de edad avanzada. Este estudio mostró una cistitis enfisematosa, una enfermedad poco fre cuente en una paciente sin ninguno de los factores de riesgo clásicos para esta entidad. Los cultivos de orina y sangre fueron positivos para Escherichia coli sensible al antibiótico empírico por lo que se continuó para completar 7 días de tratamiento. La evolución clínica fue favorable.

Abstract An 82-year-old woman with a previous medical his tory of hypertension and hypothyroidism was admitted to the emergency department for abdominal pain, dia rrhea, confusion and changes in her overall condition over several days. At the emergency department, the patient was febrile and her blood tests showed elevated C-reactive protein without leukocytosis (8.9 × 10[PRESERVECIRC]9/L). In the current context, a nasopharyngeal swab for SARS was performed and was negative. With these results, the initial suspicion was that of an infectious condi tion of gastrointestinal origin. The urine sample was foul-smelling with presence of leukocytes and nitrites and was sent out for culture. In the setting of probable urinary tract infection, empirical antibiotic treatment was started with a third generation cephalosporin. It was decided to perform a total body scanner in order to evaluate the presence of other infectious foci. The study described the presence of emphysematous cystitis, a rare pathology in a patient without any of the classic risk factors for this entity. Urine and blood cultures were positive for Escherichia coli sensitive to the empiric antibiotic which was continued to complete 7 days. The clinical course was favorable.

Emphysematous pyelonephritis in patient with hemophagocytic lymphohistiocytosis: A case report

Emphysematous pyelonephritis (EPN) and hemophagocytic lymphohistiocytosis (HLH) are rare, fatal illnesses. The presence of both at once in a patient is extremely rare. The number of reported cases of EPN is <800 cases worldwide to date. Contrarily, the prevalence of adults with HLH is estimated to be 1 in every 2000 adults admitted to a tertiary health center. This case report aims to present the case of a 45-year-old woman who was diagnosed with EPN with a history of HLH and was successfully treated with medication alone. In conclusion, the clinical manifestations of EPN are non-specific and need imaging modalities like computed tomography (CT) scans. Treating EPN is based on CT scan classification. Medical treatment was an option for these patients. There is no direct association between EPN and HLH; it is a challenging decision to treat patients with both.

Dystocia Due to Secondary Uterine Inertia and its Obstetrical Management- A Case Report

Background: A full-term pregnant Ongole cow was presented to the Large Animal Obstetrical Ward with a history of reduced feed intake, dull and ruptured foetal membranes 24 hours before presentation without progress in parturition. The temperature was within the normal physiological range. Per-vaginal examination revealed second-degree cervical dilation, lack of uterine and abdominal contractions and the vaginal discharges were reddish brown and putrid. Methods: The case was diagnosed as secondary uterine inertia and treated with an intracervical application of misoprostol and intravenous calcium therapy. Results: Three hours after the application of misoprostol and calcium therapy, full dilatation of the cervix was achieved to facilitate the delivery of the dead male emphysematous foetus by traction. Uneventful recovery of the dam was noticed. Conclusion: Usage of misoprostol along with CMC massage and calcium therapy resulted in speedy recovery of dystocia suffering with incomplete cervical dilation.

Emphysematous cystitis: two cases report / 中华泌尿外科杂志

The 2 patients were both aged females with medical history of diabetes mellitus. The chief complaints were both hyperpyrexia. Laboratory tests presented markedly elevated white blood cells and C-reactive protein, indicating severe systemic infections. Urine culture confirmed the growth of Escherichia coli. CT scan revealed thickened bladder wall with intraluminal and interstitial collections of gas. After the diagnosis of emphysema cystitis was established, conservative treatments including bladder drainage, strict glycemic control and sensitive antibiotics were administered timely. Both of the 2 patients got fully recovery after standard treatment.

Gastritis enfisematosa como manifestación de isquemia mesentérica no oclusiva tras coartectomía / Emphysematous gastritis as a manifestation of non-occlusive mesenteric ischemia after coartectomy

Resumen Las intervenciones mayores en cirugía cardiovascular de pacientes con patología aórtica pueden traer como consecuencia el compromiso de la perfusión de órganos distantes al sitio de la cirugía, siendo el tracto gastrointestinal uno de los más sensibles a los cambios hemodinámicos, en especial en grupos extremos de edad con un alto riesgo de morbimortalidad. Se reporta el caso de una lactante con antecedente de síndrome de Turner, quien es llevada a corrección de coartación de aorta más hipoplasia del arco, presentando como complicación posoperatoria un cuadro de gastritis enfisematosa con compromiso sistémico, proceso que fue favorecido por bajo gasto cardiaco posterior a bomba y presencia de urosepsis temprana, todo lo cual fue interpretado como parte del espectro del síndrome de isquemia mesentérica no oclusiva. Su diagnóstico precoz hizo posible una pronta intervención, consistente en soporte nutricional parenteral, freno ácido, antibioticoterapia de amplio espectro y seguimiento radiológico estricto, logrando la resolución completa de su sintomatología, sin complicaciones a corto plazo. Este caso demuestra que la identificación de factores de riesgo de isquemia esplácnica, una alta sospecha clínica y un cuidadoso manejo médico permiten un desenlace favorable para una patología con una alta tasa de mortalidad y muy pocos casos reportados en población pediátrica.

Abstract Major interventions in cardiovascular surgery of patients with aortic pathology can result in the compromise of perfusion of organs distant from the surgery site, the gastrointestinal tract being one of the most sensitive to hemodynamic changes, especially in extreme age groups with a high risk of morbidity and mortality. The case of a young infant is reported, with a history of Turner syndrome, who is led to correction of aortic coarctation plus arch hypoplasia, presenting as a postoperative complication a picture of emphysematous gastritis with systemic compromise, a process that was favored by low cardiac output post-pump and the presence of early urosepsis, all of which was interpreted as part of the spectrum of non-occlusive mesenteric ischemia syndrome. Its early diagnosis made possible a prompt intervention consisting of parenteral nutritional support, acid brake, broad-spectrum antibiotic therapy and strict radiological follow-up, achieving complete resolution of her symptoms, without short-term complications. This case demonstrated that the identification of risk factors for splanchnic ischemia, a high clinical suspicion and careful medical management, allowed a favorable outcome for a disease with a high mortality rate and very few cases reported in the pediatric population.

Gastritis enfisematosa en asociación con un adenocarcinoma gástrico, a propósito de un caso / Emphysematous gastritis in association with gastric adenocarcinoma. A case report

Resumen A través del presente reporte se describe un caso de gastritis enfisematosa, una rara condición clínica consistente en la invasión de la pared gástrica por microorganismos productores de gas. Puede resultar en una situación fatal debido a lo inespecífico de su clínica y a lo tórpido de su evolución. En este caso se describe a un paciente anciano de 77 años, con alta fragilidad, quien cursaba con un cuadro de gastritis enfisematosa que no respondió a manejo médico y requirió gastrectomía de urgencia. Adicionalmente, cursaba con un adenocarcinoma gástrico ulcerado infiltrante, que previamente no había sido diagnosticado, como probable factor condicionante y desencadenante.

Abstract This report describes a case of emphysematous gastritis, a rare clinical condition consisting of invasion of the gastric wall caused by gas-producing bacteria. It can lead to fatal outcomes due to the unspecific nature of the symptoms and its torpid course. The following is the case of a highly fragile 77-year-old male patient, who presented with symptoms of emphysematous gastritis that did not respond to medical treatment and required emergency gastrectomy. In addition, the patient had an infiltrating ulcerated gastric adenocarcinoma, which had not previously been diagnosed and was a probable conditioning and triggering factor.

Pielonefritis enfisematosa / Emphysematous pyelonephritis

La pielonefritis enfisematosa es una enfermedad poco frecuente. Esta consiste en una infección necrotizante severa del parénquima renal asociada a formación de gas en el sistema colector, parénquima renal y/o tejidos perirrenales. Se presenta una paciente de 54 años de edad con antecedentes de diabetes mellitus tipo 2 no controlada y litiasis urinaria, atendida en el Cuerpo de Guardia del Hospital Celia Sánchez Manduley, Granma, Cuba. Presentaba náuseas y vómitos, dolor en ambos lados de la región lumbar, y fiebre. La ecografía mostró riñones hiperecogénicos e imágenes ecorefringentes en proyección de las cavidades renales. El cultivo de orina probó la presencia de escherichia coli, y se medicó de forma endovenosa. Por evolución no favorable, se realizó tomografía que evidenció patrón gaseoso en cavidades renales. Se reajustó la antibioticoterapia parenteral y la evolución fue favorable. Se dio alta de consulta, luego de 10 meses de seguimiento asintomática, con diagnóstico de pielonefritis enfisematosa(AU)

Emphysematous pyelonephritis is a rare disease, consisting of severe necrotizing infection of the renal parenchyma associated with gas formation in the collecting system, renal parenchyma and / or peri renal tissues. We report a 54-year-old patient with history of uncontrolled type 2 diabetes mellitus and urinary stones, she was treated in the emergency service at Celia Sánchez Manduley Hospital, Granma, Cuba. She had nausea and vomiting, pain on both sides of her lower back, and fever. Ultrasound showed hyper-echogenic kidneys and echo-refractive images in projection of the renal cavities. The urine culture proved the presence of Escherichia coli, and medications was administered intravenously. Due to the unfavorable evolution, a tomography was performed and it showed a gas pattern in the renal cavities. Parenteral antibiotic therapy was readjusted and the outcome was favorable. After 10 months of asymptomatic follow-up, she was discharged from the clinic with diagnosis of emphysematous pyelonephritis(AU)

Emphysematous pyelonephritis: is conservative management effective? Our experience and review of literature

Background: Emphysematous pyelonephritis (EPN) is a urologic emergency caused by a life-threatening necrotizing infection of the kidney leading to an accumulation of gas in the renal parenchyma and perirenal tissue. we present the clinical details and outcome of twelve patients of managed at our institute and discuss their management and outcomes.Methods: Twelve consecutive patients with EPN were managed in our institute from July 2014 to July 2018. Data on demographic profile, clinical features, laboratory investigations, imaging studies, outcome of patients and follow up details were recorded.Results: Out of 12 patients with EPN, nine were female and three were male. Ten patients were diabetic (83%). All the diabetic patient had raised blood sugar at the time of admission ureteric stone was present in two nondiabetic patients. All the patients had fever at the time of presentation while localized flank pain was present in 6 (50%) patients. On examination, renal angle tenderness was present in ten patients while abdominal mass found in three patients. Pyuria was found in all patients while leukocytosis found in 10 patients. Two patients had thrombocytopenia while 4 had deranged renal parameters at the time of admission. Urine culture showed Escherichia coli in 8 patients and Klebsiella in two patients. Four patients required percutaneous drainage. Interval nephrectomy was done in one patient due to non-functioning kidney.Conclusions: Majority of patients diagnosed as emphysematous pyelonephritis were managed conservatively due to diagnosed at an early stage. Percutaneous drainage is successfully utilized in patients with more advanced disease.

Colecistitis enfisematosa: presentación de tres casos / Emphysematous cholecystitis: a report of three cases

Antecedentes: la colecistitis enfisematosa (CE) es una forma de presentación infrecuente de la colecistitis aguda. Material y métodos: presentecedentes patológicos, mientras que los otros eran diabéticos. A todos se les realizó tomografía computarizada (TC). Dos pacientes fueron sometidos a colecistectomía videolaparoscópica (CL) con buena evolución, mientras que en un caso se realizó colecistostomía percutánea (CP). Discusión: la CE se refiere a la presencia de gas en la luz o en la pared de la vesícula biliar. La tasa de morbilidad es del 50%. Los pacientes suelen padecer diabetes, pero puede presentarse en pacientes más jóvenes sin factores de riesgo. La TC es el método de elección para el diagnóstico. El tratamiento definitivo es la CL, aunque la CP es otra opción válida. Conclusión: la CL se considera un enfoque eficaz y seguro para el tratamiento de la CE.

Background: Emphysematous cholecystitis (EC) is a rare presentation of acute cholecystitis. Material and methods: We report three cases of EC in two men and one woman between 55 and 79 years. One of the patients was otherwise healthy while the other two were diabetics. A computed tomography (CT) scan was performed in all the cases. Two patients underwent video-assisted laparoscopic cholecystectomy with favorable outcome and one patient underwent percutaneous cholecystostomy. Discussion: Emphysematous cholecystitis is characterized by the presence of gas in the gallbladder lumen or wall. Mortality rate is 50%. Most patients are diabetics, but EC may present in younger patients without risk factors. Computed tomography scan is the method of choice for the diagnosis. Cholecystectomy is indicated as definite treatment, but percutaneous cholecystostomy may be a valid option. Conclusions: Laparoscopic cholecystectomy and antibiotics are effective and safe to treat.

A patient with emphysematous pyelonephritis presenting with acute kidney injury: A case report / Lao Medical Journal

@#Emphysematous Pyelonephritis (EPN) is an uncommon but life-threatening condition for which diabetic patients are at high risk. The most common chief complaint bringing patients to the hospital is upper urinary tract infection. Early clinical diagnosis with radiography is a key to reduce the complications and death due to emphysematous pyelonephritis. We present a case study of a 45-year old female patient who was presenting to the emergency room with left flank pain. Blood testing showed acute kidney injury, E. coli bacteremia, and the radiography demonstrated an abnormal image of the left kidney consistent with EPN. Symptomatic treatment and antibiotic were given, but no response and developed to heart failure and death at Emergency Room.

Clinical and Radiological Evaluation of Emphysematous Chest - A Prospective Study

Introduction: Worldwide, COPD is the major cause ofhealth care burden and the only leading cause of death that isincreasing in prevalence. Hence present study was undertakento correlate clinical and radiological findings of PulmonaryEmphysema. Imaging spectrum of Emphysema was analysedby chest X ray and computerized tomography and they werecorrelated with stages of COPD as per GOLD guidelinesbased on PFT.Material and Methods: The source of data for this prospectivestudy were 150 patients with probable diagnosis of COPDreferred to our department of Radio diagnosis. After informedconsent, clinical history and clinical examination was done.PFT, chest radiographs and CT were performed.Results: There was a significant association between X rayfinding with PFT and CT findings with PFT with P Value 0.001and P value 0.0002 respectively using Fischer’s exact test.There was a significant association between the features likehyperinflation, bullae and tubular heart noted on X ray withCT. CT was much more sensitive in diagnosis of emphysemain even mild type of COPD.Discussion: COPD is a disease of old age and is associatedwith prolonged duration of exposure to smoke and noxiousparticles. CT is undoubtedly more sensitive(100%) than chestradiographs in diagnosing emphysema and in determiningits type and extent and has a significant association withPFT.Conclusion: This hospital based study had limitations ofsmall sample size and inherent bias, but clearly shows thatCT has important diagnostic role in Emphysema with highsensitivity and specificity.

A Case of Emphysematous Cystitis with Lung Cancer at the End Stage

Introduction: We report on a patient with end-stage lung cancer who developed the relatively rare condition of emphysematous cystitis. Case: A 72-year-old man was diagnosed with carcinomatous meningitis while being treated for lung cancer and bone metastasis. Anticancer therapy was terminated, and he was transferred to our palliative care unit. During the transfer, he exhibited progressively impaired consciousness and bilateral leg paralysis. Imaging studies performed to assess his medical state revealed intrathecal nodes associated with carcinomatous meningitis and emphysema in the bladder wall. Emphysematous cystitis was diagnosed. The bladder was irrigated and drained, and antibiotic therapy was administered. Although the bladder wall emphysema resolved, the patient died of progression of carcinomatous meningitis on the 10th day after transfer. Discussion: The development of emphysematous cystitis is reported to be likely in patients with underlying diseases, such as malignant tumor, diabetes mellitus, and neurogenic bladder, as well as in those with a history of steroid use. Our patient also exhibited many risk factors, including a history of steroid use and bladder and rectal disturbance due to carcinomatous meningitis, in addition to cancer. In end-stage cancer patients, the risk of developing emphysematous cystitis is expected to be higher than in normal persons because they have often used steroids for malaise, anorexia, and other conditions, and exhibit metastasis to the central nervous system, drug-induced dysuria, and other complications. Caution should be exercised in end-stage cancer patients to recognize emphysematous cystitis, which can be life-threatening in some cases.

Rapidly Fatal Emphysematous Osteomyelitis with Multiple Septic Emboli and Liver Abscess Caused by Klebsiella pneumoniae

Emphysematous osteomyelitis, characterized by intraosseous gas, is a rare but potentially fatal condition that requires prompt diagnosis and aggressive therapy. Causative organisms are members of the bacterial family Enterobacteriaceae or anaerobes in most cases and significant comorbidities such as diabetes mellitus and malignancy, may predispose an individual to the development of emphysematous osteomyelitis. We report a case of extensive emphysematous osteomyelitis via hematogenous spread from Klebsiella pneumoniae liver abscess, complicated by gas-containing abscesses in adjacent soft tissues and epidural space, and multiple systemic septic emboli in a diabetic patient.

Rapidly Fatal Emphysematous Osteomyelitis with Multiple Septic Emboli and Liver Abscess Caused by Klebsiella pneumoniae

Emphysematous osteomyelitis, characterized by intraosseous gas, is a rare but potentially fatal condition that requires prompt diagnosis and aggressive therapy. Causative organisms are members of the bacterial family Enterobacteriaceae or anaerobes in most cases and significant comorbidities such as diabetes mellitus and malignancy, may predispose an individual to the development of emphysematous osteomyelitis. We report a case of extensive emphysematous osteomyelitis via hematogenous spread from Klebsiella pneumoniae liver abscess, complicated by gas-containing abscesses in adjacent soft tissues and epidural space, and multiple systemic septic emboli in a diabetic patient.

A clinical study of emphysematous pyelonephritis

Background: Emphysematous pyelonephritis should be suspected in every diabetic patient, presenting with features of acute pyelonephritis. E.coli is the most common organism associated with EPN. Aim: To study the clinical features, radiological classification and risk factors assess the prognostic factors and to study different management modalities of Emphysematous pyelonephritis and their outcomes. Materials and methods: It was prospective study done on 48 patients who were diagnosed to have Emphysematous pyelonephritis from various departments in Osmania General Hospital from October 2004 to October 2006 were included in the study. The diagnosis of EPN was confirmed by plain CT KUB scan. Results: All the 48 patients with EPN had diabetes mellitus (DM). All the 48 patients had poorly controlled DM. Left kidney was involved in 54.1% and Right kidney in 37.5% of cases. 6.25% of cases had bilateral involvement. Fever (93%) and tachycardia (64.5%) were most common presentation in patients. Thrombocytopenia was seen in 50% of these patients and 12% of patients with thrombocytopenia required platelet transfusion. Shock during initial presentation was seen in 22.9% of patients. 16.6% of patients presented with altered sensorium. E.coli was grown in 78% of patients and klebsiella in 6% of patients. There were 6 patients with dry EPN and 42 patients with wet EPN. 41.6% of patients had Class 2 EPN (Commonest class in our study), 25% of patients had class 3A EPN, 22.9% had Class 1 EPN, 6.25 had Class 4 EPN. 15.63% of patients were treated conservatively with antibiotics according to culture and sensitivity. 78% of patients required minimally invasive intervention. Nephrectomy was done in 6% of patients. Mortality rate in our study was 8.3%. V. Vishnu Vardhana Reddy, K. Panduranga Rao. A clinical study of emphysematous pyelonephritis. IAIM, 2018; 5(2): 150- 159. Page 151 Conclusions: Nephrectomy should be promptly attempted for patients not responding to conservative methods and patients with extensive, fulminant course of disease. Pre-existing CKD status, shock at presentation and altered sensorium are the poor prognostic factors in this study.

Aberrant Form Of Klebsiella Pneumoniae In Fulminant Emphysematous Hepatitis With Polymicrobial Infection

Klebsiella pneumoniae is a gram negative, rod shaped and non-motile bacterium of the family Enterobacteriaceae. It is encapsulated, facultative anaerobic bacteria. Bacterial morphology can be altered by various factors, including antibiotics. Unusually shaped, large, swollen organisms were observed in the liver abscess obtained from a patient with Fulminant emphysematous hepatitis with polymicrobial infection in blood. The organism was identified as Klebsiella pneumoniae by the Vitek 2 compact system.

Emphysematous Osteomyelitis due to Escherichia coli

Emphysematous osteomyelitis, especially that involving the extra-axial skeleton, is an extremely rare presentation but associated with significant morbidity and mortality. Here, we report a case in which a 58-year-old female patient with diabetes mellitus presented with emphysematous osteomyelitis that involved the sternum, clavicle, and pelvic bone and was caused by Escherichia coli via hematogenous spread of urinary tract infection. We successfully treated her with urgent and aggressive surgical drainage with prolonged antibiotics therapy. Early diagnosis and immediate surgical intervention are required for better outcomes in cases of emphysematous osteomyelitis.

Pielonefritis enfisematosa en paciente con infección por virus de inmunodeficiencia humana: reporte de caso / Emphysematous pyelonephritis in patient with human immunodeficiency virus infection: A case report

La pielonefritis enfisematosa es una infección necrosante del parénquima renal que puede afectar los tejidos perirrenales y cuyo espectro de presentación clínica, por esa razón, es variable (choque séptico, acidosis metabólica, hiperglucemia, hipoglucemia, falla renal, delirio, entre otros); la mayoría de los casos se han informado en pacientes con diabetes mellitus o presencia de uropatía obstructiva. Reportamos el caso de una paciente joven no diabética quien presentó pielonefritis enfisematosa como condición clínica que lleva al diagnóstico inicial de infección por VIH, sin otras comorbilidades relacionadas, exitosamente tratada con manejo quirúrgico y antibioticoterapia. Se realizó una búsqueda sistemática de la literatura, en la cual no se ha informado esta enfermedad como manifestación clínica que lleve al diagnóstico inicial de la infección por VIH.

Emphysematous pyelonephritis is a necrotising infection of the renal parenchyma that may affect the perirenal tissue. Thus, the spectrum of clinical presentation is variable (septic shock, metabolic acidosis, hyperglycaemia, hypoglycaemia, renal failure, delirium); most cases have been reported in patients with diabetes mellitus or obstructive uropathy. We report the case of a young female patient without diabetes who presented emphysematous pyelonephritis as the condition that led to the diagnosis of HIV infection, without related comorbidities, and who was successfully treated with surgical and antibiotical therapy. A systematic search of the literature revealed that this disease as a condition leading to an initial diagnosis of HIV infection has not been previously reported.

Emphysematous abomasitis in a lamb by bacteria of the Sarcina genus in Southern Brazil / Abomasite enfisematosa por bactérias do gênero Sarcina em um cordeiro no sul do Brasil

ABSTRACT: Abomasal bloat associated with Sarcina genus bacteria is a rare condition reported in young ruminants. An outbreak characterized by the sudden death of eight lambs from a total of 80 lambs (30 days-old) occurred on a property located in the city of Palmares do Sul in the state of Rio Grande do Sul. Deaths began to occur after the introduction of supplementation into the diet of lambs. At necropsy, the abomasum was distended by gas and had diffusely thickened walls and emphysema. On microscopic examination, the abomasum showed marked diffuse emphysema and multifocal areas of mild superficial necrosis with many coccoid structures measuring approximately 2µm in diameter, arranged in tetrads, compatible with Sarcina genus bacteria. After removing supplementation from the diet, no more deaths occurred. The diagnosis of this case was established by gross and microscopic lesions in addition to the clinical and epidemiological findings. Therefore, it was concluded that it was an outbreak of emphysematous abomasitis by Sarcina genus bacteria in lambs.

RESUMO: Timpanismo abomasal associado a bactérias do gênero Sarcina é uma enfermidade relativamente rara e reportada em ruminantes jovens. Um surto com morte súbita, acometendo oito cordeiros (30 dias de idade), de um total de 80, ocorreu em uma propriedade localizada no município de Palmares do Sul, Rio Grande do Sul. As mortes começaram a ocorrer após a introdução de suplementação na dieta dos cordeiros. Um cordeiro foi necropsiado e apresentava o abomaso distendido por gás, com parede espessada e aspecto enfisematoso. No exame microscópico, o abomaso apresentou, além de enfisema difuso acentuado, áreas multifocais de discreta necrose superficial, com inúmeras estruturas cocoides, de aproximadamente 2µm de diâmetro, arranjadas em tétrades, compatíveis com bactérias do gênero Sarcina. Após a remoção da suplementação da dieta, não ocorreram mais óbitos. O diagnóstico desse caso foi estabelecido a partir dos achados macroscópicos e microscópicos observados no abomaso e, devido à apresentação clínica e epidemiológica dos demais casos, concluiu-se que se tratou de um surto de abomasite enfisematosa em cordeiros por bactérias do gênero Sarcina.