Emphysematous Pyelonephritis and Emphysematous Cholecystitis: A Result of Uncontrolled Type 2 Diabetes

Abstract

Background: Emphysematous pyelonephritis (EPN) is a life-threatening necrotizing infection that results in the presence of gas in the renal parenchyma, collecting system, and surrounding tissues. Up to 95% of patients with EPN have underlying uncontrolled diabetes mellitus. Emphysematous cholecystitis (EC) is a necrotizing infection defined by the presence of gas in the gallbladder. Concurrent presentation of EPN and EC is limited to anecdotal cases in the literature. Case Report: We present the case of a 44-year-old female who arrived at the emergency department with signs of septic shock and diffuse abdominal pain. Diagnosis of EPN and EC was confirmed. Because the patient did not improve after aggressive medical therapy and percutaneous drainage and cholecystostomy, she was taken to surgery for emergency nephrectomy and cholecystectomy. Conclusion: In unusually extensive and severe cases of EPN, medical and minimally invasive procedures are not enough to control the infection. More aggressive management, including emergency surgery, should be implemented in selected patients who present with refractory septic shock associated with extensive disease.

Keywords: Diabetes mellitus; emphysematous cholecystitis; emphysematous pyelonephritis.

Figure 1.

Abdominal x-ray shows gas distributed in the topography of the right kidney (arrows).

Figure 2.

(A) Coronal view of contrast-enhanced computed tomography (CT) scan shows extensive parenchymal destruction of the right kidney (top asterisk) and gas extending through the retroperitoneum (bottom asterisk). (B) Axial view of contrast-enhanced CT scan shows intramural gas in the gallbladder (arrow).