Re: Gaseous bladder tamponade secondary to emphysematous cystitis.

Recently, Yang et al. (1) published the abdominal computed tomography (CT) images showing diffuse gas within the bladder wall and a prominent air-fluid level as the typical manifestation of emphysematous cystitis. However, it’s not only involved in the bladder wall but also in the bladder lumen (2, 3). We hereby present a case of gaseous bladder temponade causing obstructive uropathy a rarely severe complication of emphysematous cystitis. Our patient is a 81-year-old man who presented to the emergency department with 2 days of history of fever, progressed low abdominal distention and decreased urine output. He had type 2 diabetes mellitus and flaccid neurogenic bladder with long-term indwelling Foley catheter for the preceding two years. Laboratory studies revealed bacteriuria, leukocytosis, an elevated C-reactive protein level, high fasting blood glucose (302mg/dL), and an elevated creatinine level (2.05mg/dL). Radiography of the kidneys, ureters, and bladder revealed a low density over the whole bladder area and linear collection of gas along bladder wall (Figure-1). Abdominal CT was subsequently arranged, which showed gas tamponade in the bladder with bilateral obstructive hydronephrosis (Figure-2). A new Foley catheter was changed, and bladder irrigation was performed to extract pus and gas. He was treated with broad-spectrum Re: Gaseous bladder tamponade secondary to emphysematous cystitis _______________________________________________