Serajul Islam.
Emphysematous Cystitis: a case report.
J Postgrad Med Inst Jan ;19(3):343-4.

A 59 years old diabetic woman was admitted with 6 days history of vague abdominal pain, urinary frequency and spiking temperature up to 39.3 °C. She did not notice any pneumaturia or hematuria although urine dipstix was positive for blood and protein. She was taking Insulin (human mixtard 30) for her diabetes. She was treated by her G.P with trimethoprim 200mg BD for suspected UTI but she remained unwell and was referred to hospital. On clinical examination, she was markedly dehydrated, ill-looking obese lady with a temperature of 40.1°C, BP 100/62 mm Hg, heart rate 106/min. She was moderately tender over suprapubic area but urinary bladder was not palpable, her bowl sounds were present and there were no signs of peritonism. Laboratory results showed WCC of 23x 10e9/L, serum creatinine 177 micro mol/L, urea 27 mmol/L, glucose 26mmol/L, CRP 246mg/L, blood culture was sterile but E. Coli was isolated from urine. Abdominal X-Ray did not show any pathology but CT scan of the abdomen revealed gas in urinary bladder. Fluid and electrolytes were corrected and i.v gentamicin and ceftriaxone were started subsequently gentamicin was stopped as organism was sensitive to ceftriaxone. Her diabetes was controlled with i.v. insulin sliding scale for 4 days, subsequently human mixtard 30 was re-started. Her condition improved gradually and was discharged home after 10 days of i.v. antibiotic with a further 7 days supply of oral ciprofloxacin to which the E. Coli was sensitive too.

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