Emphysematous Cystitis With Intestinal Pseudo-Obstruction in a 72-Year-Old Woman: A Multidisciplinary Case Report

Abstract

Emphysematous cystitis (EC) is a rare, potentially life-threatening urinary tract infection characterized by gas formation within the bladder wall and lumen, typically associated with diabetes, immunosuppression, or advanced age. We present the case of a 72-year-old woman with systemic sclerosis and hypothyroidism, who was admitted for an infected distal limb wound following femoropopliteal bypass. During hospitalization, she developed emphysematous cystitis accompanied by radiological features of intestinal pseudo-obstruction. Prompt diagnosis, conservative treatment with bladder catheterization and intravenous antibiotics, and multidisciplinary management resulted in clinical improvement. This case highlights the importance of early imaging and collaborative care in atypical urinary tract infections.

Keywords: bladder wall gas; emphysematous cystitis; escherichia coli (e. coli); intestinal pseudo-obstruction; urinary tract infection.

Figure 1. Abdominal radiograph demonstrates multiple centrally located, dilated bowel loops with visible air-fluid levels.

Visible air-fluid levels indicated by arrows.

Figure 2. CT scan showing the marked gaseous distension of large bowel loops up to ~10 cm, consistent with large bowel obstruction.

Arrows indicate distended bowel loops. CT: computed tomography

Figure 3. Axial CT at the pelvic level.

The bladder is markedly distended, with intramural gas along the anterior and lateral wall, suggestive of emphysematous cystitis. Arrows indicate intramural gas. CT: computed tomography

Figure 4. Cystourethrography, oblique view.

Contrast-filled bladder without extravasation. Bladder wall irregularity visible. The arrow indicates contrast material within the urinary bladder.

Figure 5. Cystourethrography, AP view.

No evidence of perforation. The arrow indicates contrast material within the urinary bladder. AP: anteroposterior