We describe the case of a 91-year-old woman with type 2 diabetes treated with oral hypoglycemic agents, hypertensive, and with previous life-dependent physical activities of daily living after an ischemic stroke.
The family reported vomiting, hypogastric pain and hematuria in the last 15 days.
Initially treated with local anesthetic-trometamol outpatients, the clinical picture worsens in the last 48 hours, associating jaundice and generalized abdominal pain.
The patient was conscious, oriented, afflicted and normotensive.
Physical examination revealed jaundice and abdominal pain due to deep hypothermia in the hypogastrium and hypochondrium, with no associated peritoneal irritation.
Biochemistry showed poor glycemic control (glucose: 571 mg/dL), 134 acute stasis and cytolysis (total bilirubin: 10.9 mg/dL; direct bilirubin: 9.3 mg/GT 57 alkaline UPT: UGT:
The blood count is practically normal (leucocytes: 11,990/mm3 with 7 neutrophils; hemoglobin: 15.5 g/dL; platelets: 217,000/mm3).
A systematic urine analysis showed the presence of glycosuria, microhematuria and negative nitrites.
The sediment is clearly pathological, with white blood cells and germs being filled.
As complementary tests, a simple abdominal X-ray is performed, which shows the presence of ectopic air in the minor pelvis, probably in the wall, suggestive of bladder emphysematous cyst and an abdominal ultrasound, which confirms the presence of a bladder wall.
In addition, there is evidence of large dilatation of the gallbladder and intrahepatic bile duct with suspected colitis.
More than 100,000 CFU/ml of Escherichia coli sensitive to amoxicillin-clavulanic acid, cefuroxime-axlonic acid, gentamicin ( Cefuroximaxetil) and piperacillin-taametox triprimazol are isolated by uroactive.
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With the diagnosis of obstructive jaundice and emphysematous cyst, admission was decided.
Initially, intravenous antibiotic treatment was started with piperacillin-tazodone, urinary catheterization and tight glucose control.
Abdominal-pelvic CT was requested to confirm the diagnosis of emphysematous cyst.
Obstructive stricture resolved after endoscopic cholangiopancreatography and sphincterotomy. No gallstones or dilatation of the biliary tract were found on ultrasound.
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After 5 days of intravenous antibiotic treatment, the patient was discharged with oral antibiotic treatment with amoxicillin-clavulanic acid for 14 days, maintaining the urinary catheter.
The uroculture control after treatment was negative.
Control abdominal-pelvic CT showed no residual lesions.
