Submitted by Dr LAU Chun Wing Arthur on 19 Feb 2009
Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital
This patient presented with septic shock that could not be explained by the chest condition. There was some derangement of the liver function tests. An urgent CT abdomen and pelvis with contrast was performed.
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Foley’s catheter is noted. Gas pockets are noted in the urinary bladder with outpouching and apparent mural gas, ddx: urinary bladder diverticula, emphysematous cystitis. Taking into account the clinical picture and subsequent disease course, this patient actually had emphysematous cystitis.
This patient also had history of Ca rectum. Eccentric wall thickening over left lateral rectal wall and circumferential wall thickening in splenic flexure (not shown) suggestive of colonic carcinoma are again noted compared with old films. Fat plane between the rectal lesion and pelvic side wall is preserved. No enlarged perifocal lymph node is noted.
The patient recovered with antibiotics treatment alone without the need for cystectomy.