A 53-year-old woman with a history of type 2 diabetes mellitus, chronic hypertension and neurogenic bladder.
She suffered three weeks of general malaise, chills, unquantified fever, urinary incontinence, hypogastric pain and progressive abdominal volume increase.
She was admitted to our service due to a mass diagnosed as malperfused, planar jugular, temperature 37.8 oC, BP 100/60 mmHg, heart rate of 114 bpm, and heart beats per minute.
On admission, the following tests stood out: glycemia of 641 mg/dl, glycosylated Hb 9.5%, abundant hematocrit 3 dL red blood cell field 20,000 x μL, CRP 130, serum sodium 1175.3 mEq/L, plasma potassium
A pyelone was performed on admission, which showed a very distended bladder with an estimated volume of 2.340 ml, with pneumatosis of the bladder wall and severe intraluminal gas TAC.
The kidneys were observed with a slight increase in the surrounding adipose tissue, both with moderate hydroureteronephrosis.
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Emphysematous cyst associated with bilateral hydroureteronephrosis was diagnosed.
The patient was initially treated with urinary catheter Focusing the urinary tract, which gave urine a cloudy appearance and abundant gas.
It was hydrated until the deficit of ECV and electrolyte disturbances were corrected.
Hyperglycemia was corrected with insulin.
After culture collection, empirical antibiotic treatment with ceftriaxone and intravenous amikacin was initiated.
Urocultiva and blood cultures were positive for multisensitive Escherichia coli.
The clinical evolution was favorable, completing 6 weeks of antibiotic treatment with ceftriaxone.
A regression of the pneumatosis of the bladder wall and initial hydroureteronephrosis was found in the control images prior to discharge.
