Cistitis enfisematosa: una inusual forma de presentación de la infección del tracto urinario bajo / Emphysematous cystitis: Report of one case

Emphysematous cystitis is found in diabetic patients and in individuals with urinary stasis and immunosuppression. We report a 58-year-old male with hypertension, type 2 Diabetes on insulin treatment and central nervous system vasculitis on immunosuppressive therapy. He was admitted with weight loss and gait instability. A PET-CT showed a circumscribed image of air in the bladder contour without involving the upper urinary tract, suggesting emphysematous cystitis. Re-interrogated, the patient referred pneumaturia, dysuria and febrile sensation one week before admission. Urine culture showed Enterobacter aerogenes. He was treated with a urinary catheter, metabolic control and parenteral antimicrobials. The patient was discharged without symptoms 21 days after admission, with the bladder catheter.

Emphysematous Gastritis with Concomitant Portal Venous Air / 대한소화기학회지

Emphysematous gastritis is a rare form of gastritis caused by infection of the stomach wall by gas forming bacteria. It is a very rare condition that carries a high mortality rate. Portal venous gas shadow represents elevation of intestinal luminal pressure which manifests as emphysematous gastritis or gastric emphysema. Literature reviews show that the mortality rate is especially high when portal venous gas shadow is present on CT scan. Until recently, the treatment of emphysematous gastritis has been immediate surgical intervention. However, there is a recent trend of avoiding surgery because of the frequent occurrence of post-operative complications such as anastomosis leakage. In addition, aggressive surgical treatment has failed to show significant improvement in prognosis. Recently, the authors experienced a case of emphysematous gastritis accompanied by portal venous gas which was treated successfully by conservative treatment without immediate surgical intervention. Herein, we present a case of emphysematous gastritis with concomitant portal venous air along with literature review.

Pneumorraquis, espondilitis y meningitis secundarios a cistitis enfisematosa / Pneumorrhachis, spondylitis and meningitis secondary to emphysematous cystitis. Report of one case

We report a 57-year-old woman who presented with low back pain, fever and impairment of consciousness. The patient was admitted to the intensive care unit in Glasgow 8, with neck stiffness, peritoneal irritation, leukocytosis, hyperglycemia requiring insulin and a urine test suspecting an infection. Brain CT was unremarkable, while CT of the abdomen and pelvis evidenced emphysematous cystitis, retropneumoperitoneum and pneumorrhachis. Blood, urine and cerebrospinal fluid cultures were positive to Escherichia coli. She was treated with ceftriaxone, ciprofloxacin and amikacin during one month followed by ciprofloxacin until completing 100 days. The air in the spinal canal and bladder decreased. However she suffered several infectious complications such as multiple paravertebral, epidural and psoas abscesses, L5-S1 spondylitis and a L3 fracture. As an inflammatory complication she developed a bulbar infarction and tetraparesis. She had a good clinical response with medical treatment, partial improvement of the paresis and reduction of epidural abscesses.

Pielonefritis, colecistitis y cistitis enfisematosas en paciente con diabetes mellitus descompensada / Pyelonephritis, cholecystitis, and emphysematous cystitis in a diabetic patient

Background. Emphysematous pyelonephritis is a necrotizing infection characterized by gas production that usually is located in the kidney tissue, urinary tract and retroperitoneal tissue. Gas can escape following the renal veins and accumulate in the hepatic veins and other places. E coli is the most common causative organism. Clinical case: We report a 62 years old diabetic female, admitted to the hospital with a diabetic ketoacidosis. An abdominal CT scan disclosed a left emphysematous pyelonephritis, cholecystitis and cystitis. The patient was operated, performing a left nephrectomy, cholecystectomy and placement of sub hepatic and retroperitoneal drainages. The pathological study of the surgical piece showed an acute pyelonephritis with abscess formation and chronic cholecystitis. The patient died due to a multi systemic failure.

Introducción: La Pielonefritis enfisematosa es una infección necrotizante caracterizada por la producción de gas, que habitualmente se ubica en el parénquima renal, las vías urinarias y los tejidos retroperi-toneales. Cuando el gas es abundante puede escapar siguiendo las venas renales y acumularse en las venas hepáticas, y el resto del sistema. La E. coli es el patógeno más frecuente. Caso clínico: Presentamos el caso de paciente femenina de 62 años, diabética que ingresa con sintomatología de vías urinarias diagnosticada como pielonefritis enfisematosa izquierda por tomografía y encontrando como hallazgos adicionales.

Extensive renal destruction due to severe emphysematous pyelonephritis

Emphysematous pyelonephritis [EPN] is a severe necrotizing infection of the kidney characterized by the presence of gas in renal parenchyma, collecting system or perinephric tissue. It can be life threatening if not recognized and treated promptly. We have reported the case of a 56-year-old woman with a previous history of diabetes mellitus, who was suffering from left-sided flank pain and fever. Diagnosis workup revealed an extensive destruction of the left kidney secondary to an EPN. We opted for a left nephrectomy and intravenous antibiotics. The immediate postoperative course was uncomplicated but the patient developed a chronic renal failure within 1 year

A Case of Gastric Emphysema in Anorexia Nervosa Presenting as Acute Gastric Distension / 대한소화기학회지

Gas within the gastric wall is an alarming finding and a rare condition. Clinically, this condition is divided into two entities; Gastric emphysema and emphysematous gastritis. These two diseases should be differentiated because they are characterized by different clinical symptoms, possible etiology, treatment and prognosis. While emphysematous gastritis is a severe condition with high mortality, gastric emphysema is asymptomatic and usually has benign course. Rarely, anorexia nervosa and bulimia nervosa have been discribed to be associated with acute gastric distension and duodenal obstruction induced by superior mesentery artery syndrome. So, gastric emphysema could be accompanied by acute gastric distension induced by anorexia nervosa. We report a rare case of gastric emphysema in a patient with anorexia nervosa presenting as superior mesenteric artery syndrome with relevant literatures. In this case, the gastric emphysema was improved without surgical intervention after nasogastric tube for decompression and feeding insertion in the fourth portion of the duodenum.

A case of emphysematous hepatitis with spontaneous pneumoperitoneum in a patient with hilar cholangiocarcinoma / 대한간학회지

An 80-year-old woman with hilar cholangiocarcinoma was hospitalized due to sudden-onset abdominal pain. Computed tomography revealed hepatic necrosis accompanied with emphysematous change in the superior segment of the right liver (S7/S8), implying spontaneous rupture, based on the presence of perihepatic free air. Although urgent percutaneous drainage was performed, neither pus nor fluids were drained. These findings suggest emphysematous hepatitis with a hepatic mass. Despite the application of intensive care, the patient's condition deteriorated rapidly, and she died 3 days after admission to hospital. Liver gas has been reported in some clinical diseases (e.g., liver abscess) to be caused by gas-forming organisms; however, emphysematous hepatitis simulating emphysematous pyelonephritis is very rare. The case reported here was of fatal emphysematous hepatitis in a patient with hilar cholangiocarcinoma.

Emphysema as a Risk Factor for the Outcome of Surgical Resection of Lung Cancer

It is unclear whether emphysema, regardless of airflow limitation, is a predictive factor associated with survival after lung cancer resection. Therefore, we investigated whether emphysema was a risk factor associated with the outcome after resection for lung cancer. This study enrolled 237 patients with non small cell lung cancer with stage I or II who had surgical removal. Patient outcome was analyzed based on emphysema. Emphysema was found in 43.4% of all patients. Patients with emphysema were predominantly men and smokers, and had a lower body mass index than the patients without emphysema. The patients without emphysema (n=133) survived longer (mean 51.2+/-3.0 vs. 40.6+/-3.1 months, P=0.042) than those with emphysema (n=104). The univariate analysis showed a younger age, higher FEV1/FVC, higher body mass index, cancer stage I, and a lower emphysema score were significant predictors of better survival. The multivariate analysis revealed a younger age, higher body mass index, and cancer stage I were independent parameters associated with better survival, however, emphysema was not. This study suggests that unfavorable outcomes after surgical resection of lung cancer should not be attributed to emphysema itself.

Emphysematous cystitis: a case report

Emphysematous Cystitis is a primary infection of the bladder with production of gas by bacteria. The infection is uncommon, still has obvious clinical importance due to its morbidity and mortality potential, as the following case enlightens. We report a clinical case of a patient admitted with acute myocardial infarction who developed an acute emphysematous cystitis, a further complication in his long and complex period of hospitalization.

Emphysematous pyelonephritis: a case report and review of literatures.

Emphysematous pyelonephritis (EPN) is a rare fulminating, gas-forming infection of the renal parenchyma. Diagnosis of EPN is difficult if it is based only on the history, physical examination and laboratory results. But the radiological evidence is valuable for diagnosis. CT scan is the most valuable method for diagnosis. This is a case report of EPN diagnosed by plain film of the abdomen and confirmed by non-contrast CT. The patient underwent nephrectomy and EPN was confirmed by pathological finding. Diagnostic investigation of this condition was reviewed.

Emphysematous Gastritis Associated with Invasive Gastric Mucormycosis: A Case Report

Emphysematous gastritis is a rare form of phlegmonous gastritis, characterized by air in the wall of the stomach due to invasion by gas-forming microorganisms. The most commonly involved microorganisms are streptococci, Escherichia coli, Pseudomonas aeruginosa, Clostrodium perfrigens and Staphylococcus aureus. Gastrointestinal mucormycosis is another rare condition, which is most frequently occurs in the stomach. Because emphysematous gastritis associated with invasive gastric mucormycosis is an extremely rare clinical condition and both are life-threatening diseases, early precise diagnosis and early treatment should be done to avoid mortality. Herein we present an extremely rare case of emphysematous gastritis associated with invasive gastric mucormycosis. A 43-yr-old man, suffering from alcoholism and diabetes, has experienced diffuse abdominal pain for 4 days. Abdominal computed tomography scan demonstrated gas within the stomach wall. A histologic examination of the total gastrectomy specimen showed several gas-filled bubbles in the wall, along with numerous fungal hyphae throughout the necrotic stomach wall. He died of multiorgan failure secondary to disseminated mucormycosis, despite the intensive medical therapy.

Emphysematous pyelonephritis: a consequence of adenocarcinoma of urinary bladder in a nondiabetic patient.

Emphysematous pyelonephritis (EP) is a life threatening condition of acute necrotising renal parenchymal infection that encompasses a much wider spectrum of complicated urinary tract infections such as renal abscesses, emphysematous pyelitis, pyelonephritis, acute renal papillary necrosis, and sepsis. We report an unusual case of adenocarcinoma bladder in a middle aged nondiabetic patient, presenting with EP. Emphysematous pyelonephritis was the initial symptom in this case with an underlying carcinoma of the bladder. The role of imaging is prime in management of such cases, if an early diagnosis is to be made and a potentially devastating outcome is to be avoided. The literature regarding EP has been reviewed and discussed. The goals of managing EP should be (1) early institution of parenteral antibiotics and a (2) a staged nephrectomy (preceded by a temporary percutaneous drainage particularly with antibiotic resistant septicemia) so as to maximize survival rather than proceeding directly to emergency nephrectomy.

Co-occurrence of emphysematous cystitis and emphysematous myositis in type 2 diabetes.

Emphysematous cystitis (EC) and emphysematous myositis (EM) are rare disorders and concurrent occurrence of both in a patient with type 2 diabetes has not been reported previously. We report a patient who presented with pneumaturia and later with pain in thigh and diagnosed of both concurrently.

Un caso de enfisema intramuscular tras cirugía toracoscópica valorado con radiología digital / Intramuscular emphysema after thoracoscopy: digital-Rx features

El enfisema intramuscular es una entidad poco frecuente, generalmente asociada a gangrena gaseosa, siendo muy rara su aparición como extensión de un neumomediastino. En el caso presentado por nosotros el enfisema intramuscular es secundario a neumotórax espontáneo asociado inicialmente a neumomediastino y enfisema subcutáneo, visualizado tras bullectomía toracoscópica. La difusión del aire desde un neumotórax al mediastino sólo se produce en el 1-2 por ciento de los casos. La radiología digital nos permite, entre otras posibilidades, ajustar la escala de grises, aplicar filtros de imagen dependiendo de la región anatómica a estudiar o realzar los bordes de la imagen antes de su impresión en placa