Background:

Emphysematous cystitis is a rare pathology that is characterized by the presence of gas in the bladder wall caused by aerobic bacterial infection. It predominates in women and patients with diabetes mellitus, and its clinical symptoms vary.

Clinical case:

A 77-year-old man with a past medical history of uncontrolled diabetes mellitus came to the emergency department with diffuse abdominal pain in the hypogastrium, accompanied with unmeasured fever peaks. Physical examination revealed a soft, nonrigid abdomen. Deep palpation produced pain in the hypogastrium, there were no signs of peritoneal irritation, and no masses or visceromegaly were palpated. Laboratory work-up results showed leukocytosis with left shift, altered urinary sediment, pyuria, hematuria, and bacteriuria. Computed tomography identified diffuse thickening of the bladder wall and the presence of gas. Management was begun with imipenem and urethral catheter placement. The patient showed clinical improvement and the infectious process was resolved.

Conclusion:

Emphysematous cystitis requires immediate, initially conservative management through a urinary drain and adequate and specific antibiotic therapy. Surgical management is reserved for those patients that do not respond to medical treatment.