Emphysematous cystitis is a rare serious complication of urinary tract infection characterised by gas formation in the wall or lumen of the urinary bladder due to bacterial fermentation. We report a case of an 86-year-old female with emphysematous cystitis complicated by anterior bladder wall perforation. Her urine grew Escherichia coli and imaging showed gas collection inside the urinary bladder and outside the ruptured anterior bladder wall. She was treated with antibiotics and bladder irrigation and responded well without surgery. Early diagnosis and treatment improve the outcome, hence the importance of a high index of suspicion.
INtRODUCtIONEmphysematous cystitis (EC) with bladder wall perforation is a rare but potentially life-threatening complication of urinary tract infections. EC is characterised by gas collections within the bladder wall or its lumen 1 , typically affecting middle-aged diabetic women. Other risk factors are alcoholism 2 , undernutrition 3 , advanced age, debility, urinary outflow tract obstruction, structural abnormalities of the bladder and indwelling urinary catheters 4 . It is caused by gas producing organisms, Escherichia Coli (E coli) being the predominant infecting organism (58%) followed by Klebsiella pneumoniae (21%); Clostridium spp (7%) and Enterobacter spp (7%) 5 . Prompt diagnosis and treatment are warranted to prevent morbidity in this rare entity.