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Case Reports
. 2019 Dec 19:2019:8743525.
doi: 10.1155/2019/8743525. eCollection 2019.

Emphysematous Pyelonephritis Caused by a Giant Fecaloma

Mikael Abi Abdallah  1   2 , Nehme Raad  2 , Naim Yarak  1   2 , Jean Paul Noujeim  1   2 , Antoine Noujeim  2
Affiliations
Case Reports

Emphysematous Pyelonephritis Caused by a Giant Fecaloma

Mikael Abi Abdallah et al. Case Rep Urol. .

Abstract

Emphysematous pyelonephritis (EPN) is a gas-producing necrotizing bacterial infection that involves the renal parenchyma and perirenal tissue. It is a life-threatening condition that requires a high index of suspicion, an early diagnosis and an aggressive treatment. Rapid progression to septic shock may occur. We report, to the best of our knowledge, the first case of obstructive EPN caused by a giant fecaloma. The patient was successfully treated with percutaneous drainage and broad-spectrum antibiotics, in addition to fecaloma evacuation using fleet enemas and oral laxatives. This shows how fecal impaction, a common pathology in routine clinical practice, can cause some serious complications if left untreated, including extrinsic ureteral compression.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Computerized tomographic (CT) scan of the abdomen and pelvis. Left hydronephrosis with presence of air in the collecting system suggestive of left-sided emphysematous pyelonephritis (arrow). Right parapelvic cyst (empty arrow).
Figure 2
Figure 2
Computerized tomographic (CT) scan of the abdomen and pelvis. Left hydroureter with presence of intraluminal air (arrow).
Figure 3
Figure 3
Computerized tomographic (CT) scan of the abdomen and pelvis ((a): axial view, (b): coronal view). Extrinsic compression of the left midureter (arrow) between an atherosclerotic external iliac artery and a giant fecaloma.
Figure 4
Figure 4
Computerized tomographic (CT) scan of the abdomen and pelvis. The left ureter (arrow) distal to the level of obstruction was not dilated.
Figure 5
Figure 5
Follow-up noninjected computerized tomographic (CT) scan of the abdomen and pelvis. Resolution of the fecaloma and patency of the left ureter (arrow).
Figure 6
Figure 6
Antegrade ureterogram. Patency of the left ureter with absence of any intrinsic ureteral pathology.
Figure 7
Figure 7
Management of EPN according to the classification of Huang and Tseng.
See this image and copyright information in PMC

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