J Korean Soc Emerg Med.
2005 Jun;16(3):398-402.
Emphysematous Pyelonephritis Associated with Pneumoperitoneum and Pneumomediastinum: A Case Report
- Affiliations
-
- 1Department of Emergency Medicine, College of Medicine, Kyung Hee University, Seoul, Korea. edkmc@chol.com
Abstract
- Emphysematous pyelonephritis (EPN) is a life-threatening suppurative infection of the renal parenchyma, with formation of gas within the collecting system, renal parenchyma, or perirenal tissues. Since Kelly and MacCullum reported the first case of pneumaturia from a gas-forming renal infection, several terms have been used to describe the condition, such as renal emphysema, pneumonephritis, and emphysematous pyelonephritis. We describe a case of emphysematous pyelonephritis, which presented as an acute abdomen with pneumoperitoneum and pneumomediastinum in a diabetic patient. A subsequent exploratory laparotomy did not identify the site of visceral perforation or the source of infection, and an ensuing nephrectomy with intensive antibiotic therapy was lifesaving. Occasionally, retroperitoneal infection can contaminate the peritoneal cavity and produce gas to create pneumoperitoneum, and retroperitoneal air can migrate to the mediastinum to create a pneumomediastinum. Therefore, we recommend that a differential diagnosis of a pneumoperitoneum or a pneumomediastinum should also include retroperitoneal infection, such as emphysematous pyelonephritis.
