Alpha DY Lin

Taipei Hernia Center, the Central–Clinic General Hospital, Taipei

林鼎淯 台北疝氣手術中心 中心綜合醫院

 

We herein report a case of rupture of the urinary bladder due to emphysematous cystitis. The patient was an 55-year-old male with DM who was hospitalized for surgery of right side inguinal hernia. Postoperative recovery was stable with well self-voiding, and was discharged on the same surgery day. Two days after surgery, he arrived ER with acute urinary retention and lower abdominal pain.

Emergent CT revealed right UVJ stone and distended urinary bladder without signs of rupture. Foley catheter was indwelled and turbid urine was recored in 700ml. Urine routine revealed pyuria. The patient was admitted and emperical treatment was carried out under the impression of UTI and urolithiasis. Blood count revealed leukocytosis with low lymphocyte. Foley catheter was removed in the next day with smooth self-voiding for two continual days. However, subcutaneous edema was proved by sonography, without urinary bladder rupture. On day 6 after hernia surgery, urine collected in the ER (on day 3 after surgery) eventually cultured bacteria Klebsiella pneumonia (KP). Foley catheter was indwelled again to prevent emphysematous necrotizing cystitis. Corresponding antibiotics was given. The lower abdominal subcutaneous edema gradually shrinkage and general physical condition improved after then.

Despite urinary drainage and antibiotic therapy, Day 10 after surgery, he ran an extraperitoneal ruptured urinary bladder with urine leaked via hernia surgery wound. The urine-fluid collected from hernia wound and Foley catheter both showed no bacteria. He was transferred to a tertiary medical center for further treatment and thereafter urinary bladder was repaired. The patient was discharged with well recovery after the surgery. Although KP bacteria induced necrotizing cystitis occurred rarely, for the DM and/or immune compromised patient, urinary bladder and potential progressive pyelonephritis and sepsis should be alerted.