Chang Chirn-Bin, Chang Chia-Chu
Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
J Emerg Med. 2011 May;40(5):506-8. doi: 10.1016/j.jemermed.2007.11.068. Epub 2008 Nov 7.
Emphysematous cystitis is a relatively rare infectious condition of the urinary bladder. The mortality rate is high if the diagnosis is delayed or if the treatment is inadequate. We present an uncommon case of emphysematous cystitis and highlight the risk factors for this disease. An 81-year-old man with a past medical history of type 2 diabetes and a central pontine infarction presented to the Emergency Department due to gross hematuria. Computed tomography (CT) and plain radiography revealed localized gas within the bladder that was compatible with the diagnosis of emphysematous cystitis. A Foley catheter was inserted. Urine culture grew Klebsiella pneumoniae; 2 g cefotaxime daily was initiated. Subsequent plain radiography and CT scan showed regression of intraluminal gas. We recommend CT for the definitive diagnosis of emphysematous cystitis. Adequate antibiotic therapy, strict blood glucose control, adequate drainage of urine, and early goal-directed therapy for suspected sepsis are suggested to prevent the complications of emphysematous cystitis.
气肿性膀胱炎是一种相对罕见的膀胱感染性疾病。如果诊断延迟或治疗不当，死亡率很高。我们报告一例罕见的气肿性膀胱炎病例，并强调该疾病的危险因素。一名81岁男性，既往有2型糖尿病和脑桥中央梗死病史，因肉眼血尿就诊于急诊科。计算机断层扫描（CT）和平片显示膀胱内有局限性气体，符合气肿性膀胱炎的诊断。插入了一根Foley导尿管。尿培养结果为肺炎克雷伯菌；开始每日使用2克头孢噻肟。随后的平片和CT扫描显示腔内气体消退。我们建议采用CT来明确诊断气肿性膀胱炎。建议进行充分的抗生素治疗、严格控制血糖、充分引流尿液以及对疑似脓毒症进行早期目标导向治疗，以预防气肿性膀胱炎的并发症。
