謝肇新、童敏哲、許兆畬、殷約翰、戴浩平

陳祥來、黃鐘銘、翁瑋駿、黃立華、李毅彥

童綜合醫院 外科部 泌尿科

Siu-San Tse, Min-Che Tung, Chao-Yu Shu, Jue-Hawn Yin, Hao-Ping Tai,

Hsiang-Lai Chen, Zhon-Min Huang, Wei-Chun Weng, Li-Hua Huang, I-Yen Lee

Divisions of Urology, Department of Surgery,

Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan

 

    Urinary tract infection is the most common condition in urology clinical practice. Severe infection or even sepsis is mostly occurred in upper urinary tract. Emphysematous pyelonephritis is occasional noted and is life-threatening but emphysematous cystitis is rarely seen.

    We presented one 92 y/o female and one 65 y/o female who visited our emergency room at March and November of 2014 respectively. Their chief complaints included fever, general weakness, cough, shortness of breath and were not specific. There was no lower urinary tract symptom except low abdominal discomfort were complained in both cases. Complete blood count showed leukocytosis with left shift in both of them. Urinalysis both showed hematuria and pyuria. High blood sugar level were noted in these two cases. Diabetic mellitus was newly diagnosed in the 92 y/o case and diabetic mellitus with poor control was impressed in the 65 y/o case. KUB disclosed suspicious emphysema around the mild distended urinary bladder of these two patients. Abdominal CT revealed diffuse air retention in the distended urinary bladder wall of both patients. Foley catheters were indwelled at once at ER and were admitted to our intensive care unit with antibiotic treatment. Conservative treatment were given in these two patients and they discharged weeks later without any complications.

    Lower urinary tract infection especially cystitis was commonly noted in our daily practice. Some conditions may aggravate the infection, for example, the immunocompromised status of the patient, voiding function, or any organic problem. We presented our experience in managing these two cases and reviewed the literature.