Emphysematous pyelonephritis, a rare cause of pneumoperitoneum: a case report and review of literature

Abstract

Introduction: Emphysematous pyelonephritis is a gas-producing necrotizing bacterial infection that involves the renal parenchyma and perirenal tissue.

Case presentation: We report on a case of a 55 year old Caucasian male with no prior medical history presented with left flank pain and malaise. He was diagnosed with emphysematous pyelonephritis, and was successfully treated in our department. The case is presented along with a literature review.

Conclusion: Prompt diagnosis and early treatment is crucial because of the high rate of mortality. Therapeutic modalities and prognostic factors regarding emphysematous pyelonephritis remain controversial.

Figure 1

Abdominal CT; intraperitoneal air in the upper abdomen sets the diagnosis of acute abdomen necessitating surgical exploration.

Figure 2

CT scan of the abdomen revealed extensive collections of gaseous fluid mainly in the left retroperitoneum extending along the paracolic gutter and to the middle. The air in the dilated left renal calyces gives the only clue to the diagnosis (arrow).