ABSTRACT
OBJECTIVE: To report one case of emphysematous cystitis and to review its diagnosis and treatment in the related literature. METHOD: We report the case of a type II diabetic 91-year-old woman with jaundice, hematuria, vomits, abdominal pain and poor glycemia control. Diagnosis was obtained by plain abdominal X-ray and ultrasonography, and confirmed by CT. E.coli was isolated in urinary culture. RESULTS: Antibiotic intravenous therapy with piperacillin-tazo-bactam, urinary bladder catheterization and strict glycemia control. The patient was discharged from hospital on day 5, with 14 additional days of orally administered amoxicillin-clavulanic and bladder catheterization. Complete clinical, radiologic and microbiologic resolution was achieved. CONCLUSIONS: Emphysematous cystitis is a rare entity, most common in diabetic women, which results from infection of the urinary bladder with gas-producing pathogens, mainly E.coli. Clinical presentation is variable. Emphysematous cystitis can be diagnosed radiologically, mainly with CT scan. The management consists of broad-spectrum antibiotics, strict glycemic control and bladder drainage. Emphysematous cystitis usually has a benign course, but complications may arise in up to 10-20% of cases, requiring surgical treatment.
Subject(s)
Cystitis , Emphysema , Aged, 80 and over , Cystitis/complications , Cystitis/diagnosis , Cystitis/therapy , Emphysema/complications , Emphysema/diagnosis , Emphysema/therapy , Female , HumansABSTRACT
OBJECTIVE: To report a case of splenosis and to review its diagnosis and treatment in the related literature. METHOD: We report the case of an asymptomatic 49-year-old man with splenectomy performed when he was 22. Lumbo-sacral MRI showed a left perirenal mass probably with renal origin. RESULTS: CT scan ruled out the renal origin. Due to previous splenectomy, splenosis was suspected. 99mTc-labeled heat-damaged erythrocytes scan confirmed the diagnosis. No treatment was applied. CONCLUSIONS: Clinicians should be aware that unknown origin masses, mainly in the peritoneal cavity, with a history of previous splenic trauma or splenectomy, might represent splenosis. A non-invasive diagnosis can be achieved with 99mTc-sulphur colloid scan, 99mTc-labeled heat-damaged erythrocytes or ferrumoxide-enhanced MRI, thus avoiding unnecessary surgical explorations.
Subject(s)
Kidney Neoplasms/diagnosis , Splenosis/diagnosis , Diagnosis, Differential , Humans , Male , Middle AgedABSTRACT
Resumen.- OBJETIVO: Presentar un caso de cistitis enfisematosa y revisar aspectos diagnósticos y terapéuticos en la literatura relacionada.MÉTODO: Presentamos el caso de una mujer de 91 años, diabética tipo II, con ictericia, hematuria, vómitos, dolor abdominal y mal control glucémico. El diagnóstico inicial fue mediante radiografía simple de abdomen y ecografía abdominal, luego confirmado con TC. Urocultivo positivo para Escherichia coli.RESULTADOS: Tratamiento antibiótico intravenoso con piperacilina-tazobactam, sondaje vesical y control estricto de las glucemias. Alta hospitalaria a los 5 días con sonda urinaria y tratamiento antibiótico vía oral durante 14 días con amoxicilina-clavulánico. Completa resolución clínica, radiológica y microbiológica del cuadro.CONCLUSIONES: La cistitis enfisematosa es una entidad poco frecuente, típica de mujeres diabéticas, producida por microorganismos productores de gas, principalmente E.coli. Su presentación clínica es variable. El diagnóstico generalmente se realiza por métodos de imagen, fundamentalmente TC. El tratamiento consiste en drenaje vesical, estricto control glucémico y antibioterapia de amplio espectro. El pronóstico suele ser favorable, salvo en un 10-20% de los casos, en los que se requiere intervención quirúrgica(AU)
OBJECTIVE: To report one case of emphyse-matous cystitis and to review its diagnosis and treatment in the related literature.METHOD: We report the case of a type II diabetic 91-year-old woman with jaundice, hematuria, vomits, abdominal pain and poor glycemia control. Diagnosis was obtained by plain abdominal X-ray and ultrasonography, and confirmed by CT. E.coli was isolated in urinary culture. RESULTS: Antibiotic intravenous therapy with piperacillin-tazo-bactam, urinary bladder catheterization and strict glycemia control. The patient was discharged from hospital on day 5, with 14 additional days of orally administered amoxicillin-clavulanic and bladder catheterization. Complete clinical, radiologic and microbiologic resolution was achieved.CONCLUSIONS: Emphysematous cystitis is a rare entity, most common in diabetic women, which results from infec-tion of the urinary bladder with gas-producing pathogens, mainly E.coli. Clinical presentation is variable. Emphysema-tous cystitis can be diagnosed radiologically, mainly with CT scan. The management consists of broad-spectrum antibiotics, strict glycemic control and bladder drainage. Emphysema-tous cystitis usually has a benign course, but complications may arise in up to 10-20% of cases, requiring surgical treat-ment(AU)
Subject(s)
Humans , Female , Aged, 80 and over , Cystitis/diagnosis , Cystitis/therapy , Anti-Bacterial Agents/therapeutic useABSTRACT
OBJETIVO: Presentar un caso de esplenosis y revisar aspectos diagnósticos y terapéuticos en la literatura relacionada.MÉTODO: Presentamos el caso de un varón de 49 años, esplenectomizado a los 22 años. Hallazgo incidental de una masa perirrenal izquierda en RM lumbo-sacra, de probable origen renal. RESULTADOS: Se realiza TC abdómino-pélvico descartando el origen renal de la masa. Dado el antecedente de esplenectomía la sospecha diagnóstica fue de esplenosis. Se realizó gammagrafía hepato-esplénica con hematíes desnaturalizados marcados con 99mTc confirmando el diagnóstico. Se decidió abstención terapéutica.CONCLUSIONES: Ante el hallazgo de masas de origen desconocido, fundamentalmente en la cavidad peritoneal, debe ser tenida en cuenta la posibilidad diagnóstica de esplenosis, sobre todo si existe un antecedente de lesión esplénica traumática o quirúrgica. Para su diagnóstico se pueden emplear pruebas no invasivas elevada especificidad, como la gammagrafía hepato-esplénica, la gammagrafía esplénica con hematíes desnaturalizados, o la RM con ferumóxido, evitando exploraciones quirúrgicas innecesarias(AU)
Summary.- OBJECTIVE: To report a case of splenosis and to review its diagnosis and treatment in the related literature.METHOD: We report the case of an asymptomatic 49-year-old man with splenectomy performed when he was 22. Lumbo-sacral MRI showed a left perirenal mass probably with renal origin.RESULTS: CT scan ruled out the renal origin. Due to previous splenectomy, splenosis was suspected. 99mTc-labeled heat-damaged erythrocytes scan confirmed the diagnosis. No treatment was applied.CONCLUSIONS: Clinicians should be aware that unknown origin masses, mainly in the peritoneal cavity, with a history of previous splenic trauma or splenectomy, might represent splenosis. A non-invasive diagnosis can be achieved with 99mTc-sulphur colloid scan, 99mTc-labeled heat-damaged erythrocytes or ferrumoxide-enhanced MRI, thus avoiding unnecessary surgical explorations(AU)
