Download PDF
Rofo 2024; 196(03): 294-296
DOI: 10.1055/a-2124-2175
The Interesting Case

Perforated emphysematous cystitis with widespread extraperitoneal gas and subcutaneous emphysema

Perforierte emphysematöse Zystitis mit ausgedehnter extraperitonealer Gasbildung und subkutanem Emphysem
Ksenija Mijović 
1   Center for Radiology, University Clinical Center of Serbia, Belgrade, Serbia (Ringgold ID: RIN63740)
,
Dragan Vasin
2   Center for Radiology, Department of Emergency Radiology, University Clinical Center of Serbia, Belgrade, Serbia (Ringgold ID: RIN63740)
3   School of Medicine, University of Belgrade, Belgrade, Serbia (Ringgold ID: RIN54801)
,
Emina Talakic 
4   Radiology, Medical University of Graz, Graz, Austria (Ringgold ID: RIN31475)
,
Aleksandar Pavlović
1   Center for Radiology, University Clinical Center of Serbia, Belgrade, Serbia (Ringgold ID: RIN63740)
,
Dragan Mašulović
1   Center for Radiology, University Clinical Center of Serbia, Belgrade, Serbia (Ringgold ID: RIN63740)
3   School of Medicine, University of Belgrade, Belgrade, Serbia (Ringgold ID: RIN54801)
,
Aleksandra Djurić-Stefanović
1   Center for Radiology, University Clinical Center of Serbia, Belgrade, Serbia (Ringgold ID: RIN63740)
3   School of Medicine, University of Belgrade, Belgrade, Serbia (Ringgold ID: RIN54801)
5   First Surgery University Clinic, Center for Radiology, Department of Digestive Radiology, University Clinical Center of Serbia, Belgrade, Serbia (Ringgold ID: RIN63740)
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Introduction

Emphysematous cystitis (EC) is an uncommon urinary tract infection (UTI) characterized by proliferation of anaerobic bacteria in the bladder wall with subsequent intramural gas, which is considered pathognomonic (Wojack PR, Clin Imaging. 2020 Sep;65:1–4). It usually occurs in the elderly, with female predominance. The most important risk factor is diabetes mellitus, but it also happens in the setting of immunosuppression, neurogenic bladder, obstructive uropathy, and indwelling urinary catheter (Gunawardene MC, Int Surg J 2021;8:3441–3).

In a recent 20-year literature review, spontaneous bladder rupture in patients with EC was present in 5 of 113 cases (Ranjan SK, Urol Ann. 2021 Jul–Sep;13(3):312–315), and our literature search revealed only 3 reported cases with associated subcutaneous emphysema (Gunawardene MC, Int Surg J 2021;8:3441–3, Sadek AR, Int J Emerg Med. 2011 Jun 13;4(1):26, Datta NS, Urology. 1978 Dec;12(6):701–3).

We present a peculiar case of EC with extensive extraperitoneal gas and subcutaneous emphysema without a radiologically detected site of bladder wall perforation.



Publication History

Received: 11 May 2023

Accepted after revision: 03 July 2023

Article published online:
15 August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany