Description
A Caucasian woman aged 65 years with a history of chronic alcoholism presented to the hospital with confusion. Abdominal examination revealed lower abdominal tenderness with no guarding or rigidity. Ethanol level was 378 mg/dL (<10 mg/dL: absent; >300 mg/dL: potentially fatal level) and blood counts in low normal range. Lactic acid was elevated to 3.6 mmol/L and urinalysis revealed pyuria, haematuria, 4+bacteria and positive leucocyte esterase. CT scan of the abdomen showed air within the bladder wall without urinary calculus or obstruction (figures 1 and 2). Patient's mental status improved with intravenous hydration and ertapenem. Urine culture showed heavy growth of levofloxacin-sensitive Escherichia coli and the antibiotic was narrowed down. Abdominal ultrasound scan performed after 14 days showed resolution of free air in bladder walls.
Figure 1
Sagittal CT image of the abdomen showing free air in bladder walls diagnosed as emphysematous cystitis.
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