Emphysematous perinephric abscess without diabetes or urinary obstruction

Emphysematous pyelonephritis is a rare disease seen usually in patients with diabetes mellitus or obstructive uropathy. We report a case of emphysematous pyelonephritis in a male who had no evidence of diabetes or obstructive uropathy. Such an occurrence of emphysematous pyelonephritis without diabetes or obstructive uropathy is very rare. The patient was managed with antibiotics, supportive measures and surgical drainage and he recovered completely.     

Emphysematous pyelonephritis complicated with diabetes mellitus: a case report]

A 46-year-old woman with diabetes mellitus was admitted to our hospital due to lower right abdominal pain. Urinalysis did not show marked pyuria. Abdominal computed tomography showed an abnormal gas shadow in the right renal parenchyma. A diagnosis was made of right emphysematous pyelonephritis. Despite aggressive supportive therapy, the patient's condition worsened. Therefore, right nephrectomy was performed. The next day her general condition was markedly improved. We reviewed 122 cases of emphysematous pyelonephritis including our case in the Japanese literature, and discussed its etiology, symptomatology, choice of treatment and prognosis.     

气肿型肾盂肾炎合并2型糖尿病1例报道

目的气肿性肾盂肾炎在临床实践中比较罕见。它是一种严重的危及生命的急性暴发性肾脏感染性疾病,其主要特征是产气致病菌产生的气体在肾脏集合系统内、肾实质内及肾周围形成并集聚。气肿性肾盂肾炎的预后通常比较差,现报道本院诊治的气肿性肾盂肾炎合并2型糖尿病1例并进行文献回顾。方法患者女,51岁,因"高热3 d,腹胀伴呕吐2 d"急诊入院。术前CT示右肾形态失常、实质欠连续,内见多发积气影,似累及肾盂、肾周间隙、肾旁间隙及下腔静脉周围散在积气,邻近肠壁稍显肿胀。由于保守治疗疗效不佳,患者最终于全麻下行右肾全切除术。结果患者恢复良好并于术后1周出院。结论气肿性肾盂肾炎在临床上少见并且病死率较高。由于其临床表现缺乏特异性而容易误诊和漏诊。腹部CT是目前确诊气肿性肾盂肾炎的首选影像工具,它可以帮助确定感染的程度并指导治疗。在疾病早期可以采用肾穿刺引流和强效抗生素的联合治疗方案。然而,如果肾无功能,患者病情恶化或者存在预后不良因素,临床医师应该立即采用肾切除术来有效治疗气肿性肾盂肾炎。     

Emphysematous pyelonephritis: a case report

In this study, a case of emphysematous pyelonephritis has been reported in a 70-year old diabetic male with a non-functional contralateral kidney. In spite of appropriate medical treatment and surgical drainage, the outcome was negative. The case in question concerned a rare form of the disease, i.e., emphysematous pyelonephritis, a severe and necrotizing infection which is characterized by the presence of intraparenchymal gas produced by anaerobic bacteria, and the rapid development of acute sepsis or septic shock. Medical treatment alone is seldom sufficient, and surgical intervention, in most instances consisting of radical nephrectomy rather than surgical drainage, is advocated due to the extent of the necrotic lesions.     

Emphysematous pyelonephritis: a case report

Diabetic patients with urinary tract infections had a certain risk of developping emphysematous pyelonephritis with gas producting bacteria. This disease was accompagned with high mortalité. We will report one case who was treated successfully by high dose antibiotic regim and emergency nephrectomy.     

Emphysematous pyelonephritis complicated by liver cirrhosis and diabetes mellitus: a case report and a review of the literature

A case of emphysematous pyelonephritis is presented and a review of literatures is made. A 67-years-old woman with diabetes mellitus, complained of severe left flank pain and high fever and was referred from the department of gastroenterology. A computed tomography film demonstrated gas in the left renal parenchyma and a diagnosis of emphysematous pyelonephritis was made. She was in a state of shock and died after 4 days of conservative treatment. Emphysematous pyelonephritis is a rare, life-threatening disorder and 85 cases in the world have been reported to date. Our case is the 18th one in Japan. Its etiology, symptomatology, treatment and prognosis are discussed.     

Emphysematous pyelonephritis: report of a case

A case of emphysematous pyelonephritis is presented. A 49-year-old male with diabetes mellitus complaining of high grade fever attack and right flank pain was referred from internal medicine. KUB demonstrated that the right ureter, pelvis and calyces were filled with gas. Anti-bioticus was given intensively and the abnormal gas shadow on plain film disappeared before RP was done, but high grade fever attack persisted and right nephrectomy was undergone. After this operation, the fever was relieved and the patient was discharged at the 30th day post-operatively. A search of available literature in Japan has disclosed only 17 reported cases. Diagnostic methods, treatment, complication and etiology are discussed.     

Emphysematous pyelonephritis: report of a case

A case of emphysematous pyelonephritis is presented. A 54-year-old woman with diabetes mellitus was admitted because of bilateral ureteral stones. Five days after bilateral ureterolithotomy, she developed left flank pain, chills and fever. Plain x-rays of the abdomen (KUB) showed an enlarged left kidney with a giant gas shadow on the left renal area and no evidence of stone shadow. Drip infusion pyelogram revealed a decrease in the left renal function and the presence of the gas in the pyelocalyceal system. Contrast-enhanced computerized tomograms confirmed the presence of the gas in the parenchyma and pyelocalyceal system. The patient was treated conservatively with intensive antibiotic therapy, intravenous fluids and control of diabetes mellitus. After 3 weeks of therapy, the gas shadow disappeared, and a good recovery of renal architecture and function was achieved.     

Emphysematous cystitis: report of a case.

Emphysematous cystitis is characterized by gas collection within the bladder wall and lumen. A case of emphysematous cystitis in a 74-year-old diabetic male is reported. Radiogram demonstrated an enlarged bladder with intraluminal gas.     

Emphysematous cholecystitis: report of a case.

A case is reported of emphysematous cholecystitis that occurred seven months after vagotomy and hemigastrectomy (with Billroth II reconstruction). It was successfully treated by means of initial cholecystostomy and interim cholecystectomy six weeks later. Although it has been urged by some that an emergency operation is always indicated in this condition, in the case presented, the timing of the operation was determined by the overall clinical picture of the patient.     

Toothpick in a perinephric abscess

A toothpick was encountered in the cavity of a perinephric abscess, and was thought to have perforated the posterior wall of the ascending colon.     

Emphysematous pyelonephritis and renal amoebiasis in a patient with diabetes mellitus

Emphysematous pyelonephritis is an uncommon and life-threatening infection of the kidney that is characterized by gas formation within or around the kidney and is associated with diabetes mellitus and urinary tract infection. Amoebiasis is a protozoal infection caused by Entamoeba histolytica. In its invasive forms, the disease is characterized by visceral abscess formations. We present a case of concomitant emphysematous pyelonephritis and renal amoebiasis in a 42-year-old female with uncontrolled diabetes mellitus. The patient did not respond well to initial supportive treatment and antibiotherapy. Therefore, nephrectomy was performed. She did extremely well after the operation and was discharged with antidiabetics and antibiotics.     

糖尿病合并细菌性肝脓肿与布鲁菌病一例

目的提高医务工作者对非典型布鲁菌病的认识。 方法分析1例布鲁菌病合并肝脓肿及初发糖尿病患者的诊疗过程，并结合相关文献进行复习。 结果1例66岁老年男性布鲁菌病合并肝脓肿及2型糖尿病患者，予以综合抗感染治疗，引流肝脓肿及降糖对症治疗后，患者体温正常，布鲁菌病及肝脓肿病情好转后出院，后期随访疗效显著。 结论及时确诊及规范治疗是控制布鲁菌病、肝脓肿病情及预后的关键。     

Laparoscopic treatment of a perinephric abscess

A 21-year-old woman was operated laparoscopically for peritonitis due to penetrating perinephric abscess (PNA). Following correct diagnosis and drainage, a definitive treatment was carried out to drain the intrarenal abscess laparoscopically.Although not the preferred approach, when diagnosed during exploratory laparoscopy for peritonitis, PNA can be successfully treated laparoscopically.     

Pancreatic abscess: a case report

The case history of an 81-year-old man who developed a large pancreatic abscess following pancreatitis is presented in depth. The underlying cause was biliary tract disease, and the patient successfully underwent cholecystectomy, choledocholithotomy, and drainage of the pancreatic abscess. Several important points in the management of this problem are emphasized.     

Hepatic abscess produced by extension of a perinephric abscess

A case of hepatic abscess resulting from direct extension of a perinephric abscess in a patient with chronic urinary tract infection is presented. Anatomic variation contributing to this disease and its clinical features are discussed. Other causes of hepatic abscess are reviewed briefly.     

Emphysematous pyelonephritis due to Aspergillus fumigatus: a case report

A case of acute emphysematous pyelonephritis (EPN) caused by Aspergillus fumigatus is reported in a non-diabetic patient, who did not apparently have any risk factors for fungal infection. The patient refused any surgical intervention and was successfully treated with liposomal amphoteracin-B and 5-flucytocin and achieved complete recovery.