A Rare Case of Emphysematous Urethritis

The patient underwent emergency surgical exploration of his perineum, excision of urethra and insertion of a suprapubic catheter by expanding the bladder with the urethral catheter that was placed at admission. The pus-filled collection surrounding the urethra was drained and all necrotic tissue derided. Samples of tissue were sent to the Microbiology Laboratory, isolating Streptococcus miller and Bactericides fragilis. Histology showed extensive infarction of the corpus spongiosum and overlying urethral urothelium; there was associated dense acute inflammation with abscess formation. This was consistent with necrotising fasciitis. The patient continued treatment with co-amoxiclav and metronidazole. A further exploration of the perineal wound was performed 48 hours after the initial surgery. At second operation, the wound was clean with no further signs of necrosis or infection. A repeat CT abdomen was performed on Day 5 following admission which showed 3 newly developed hypo-dense splenic lesions (in keeping with infarction), as well as a large infarcted area in the upper pole and mid pole cortex of the left kidney. This was thought likely to be secondary to sepsis.