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Dong X, You S, Zhang H, Wang D, Pan W, Zhang B, Huang S, Li X, Pang J, Ji W. Venous gas caused by emphysematous pyelonephritis: a case report and review of literature. BMC Urol 2022; 22:154. [PMID: 36123660 PMCID: PMC9487055 DOI: 10.1186/s12894-022-01104-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emphysematous pyelonephritis (EPN) is a potentially life-threatening disease caused by a gas-producing necrotizing bacterial infection that involves the renal parenchyma, collecting system, and/or perinephric tissue. EPN is often complicated by a previous diagnosis of diabetes mellitus, and venous air bubbles are an uncommon complication of it. We describe a 52-year-old woman who was admitted in coma, with a history of vomiting, and was found to have EPN with air bubbles in the uterine veins. We discuss the presentation, diagnosis, and pathogenesis of this uncommon but clinically significant event, and briefly review other case reports of venous gas or thrombosis caused by EPN. CASE PRESENTATION We report the case of a 52-year-old woman with past history of type 2 diabetes mellitus, presenting with loss of consciousness after vomiting for half a day. Abdominal computed tomography scan revealed unilateral EPN with air bubbles in the uterine veins. The blood, pus, and urine cultures were positive for extended-spectrum beta-lactamase-producing Escherichia coli. The patient's condition improved well after conservative management comprising supportive measures, broad-spectrum antibiotics, percutaneous drainage therapy, and an open operation. CONCLUSIONS Venous air bubbles are rare but fatal complication of EPN. Early diagnosis and treatment are critical to ensure good results.
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Affiliation(s)
- Xue Dong
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Shuzong You
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Huangqi Zhang
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Dongnv Wang
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Wenting Pan
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Binhao Zhang
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Shanqiang Huang
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Xin Li
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Jianxin Pang
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Wenbin Ji
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China.
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CHENG ML, NORDING H, LIM CH. Bilateral Emphysematous Pyelonephritis with Hepatic Portal Venous Gas: Case Report. Malays J Med Sci 2015; 22:71-74. [PMID: 26715900 PMCID: PMC4681725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/05/2014] [Indexed: 06/05/2023] Open
Abstract
Emphysematous pyelonephritis is a rare life-threatening condition caused by a severe acute necrotising infection of the renal parenchyma and its perinephric tissues, and it is commonly seen in diabetic patients. There is a rare association between emphysematous pyelonephritis and hepatic portal venous gas. Hepatic portal venous gas is an uncommon radiological finding, which implies a significant underlying abdominal disease. The management of emphysematous pyelonephritis has evolved from prompt nephrectomy to medical therapy. In the present report, we present a case of a diabetic woman diagnosed with bilateral emphysematous pyelonephritis with hepatic portal venous gas that was successfully managed medically despite the presence of poor prognostic factors, such as acute renal failure and thrombocytopenia.
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Affiliation(s)
- Mao Li CHENG
- Department of Surgery, Hospital Segamat, KM 6, Jalan Genuang, 85000 Segamat, Johor, Malaysia
| | - Hasnizal NORDING
- Department of Surgery, Hospital Segamat, KM 6, Jalan Genuang, 85000 Segamat, Johor, Malaysia
| | - Chen Hong LIM
- Department of Surgery, Hospital Segamat, KM 6, Jalan Genuang, 85000 Segamat, Johor, Malaysia
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Sun JN, Zhang BL, Yu HY, Wang B. Severe emphysematous pyelonephritis mimicking intestinal obstruction. Am J Emerg Med 2015; 33:1846.e3-6. [PMID: 25957142 DOI: 10.1016/j.ajem.2015.04.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/09/2015] [Indexed: 12/22/2022] Open
Abstract
Emphysematous pyelonephritis is a severe necrotizing infection characterized by the presence of gas and/or fluid in the renal parenchyma, collecting system, or perirenal tissues. Emphysematous pyelonephritis with approximately 15 cm air-fluid level, diffused ureteral involvement, and the accumulation of gas in liver and peritoneal cavity is very rare. Here, we reported a severe emphysematous pyelonephritis with multiple huge air-fluid level mimicking intestinal obstruction and with the accumulation of gas in liver and ureter in computed tomography imaging. The patient was successfully managed by percutaneous nephrostomy combined with medical treatment.
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Affiliation(s)
- Ji Ning Sun
- Shandong Medical Imaging Research Institute, Shandong University, No. 324, JingWu Road, Jinan 250021, Shandong, China; Department of Radiology, Weifang People's Hospital, No. 151, Guangwen Street, Kuiwen District, Weifang 261041, Shandong, China
| | - Bao Long Zhang
- Department of Radiology, Weifang Maternity and Child Care Hospital, No. 76, Qingnian Road, Weicheng District, Weifang 261011, Shandong, China
| | - Hai Yan Yu
- Department of Radiology, Weifang People's Hospital, No. 151, Guangwen Street, Kuiwen District, Weifang 261041, Shandong, China
| | - Bin Wang
- Binzhou Medical University, No. 346, Guanhai Road, Laishan District, Yantai 264003, Shandong, China.
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