Emphysematous cystitis due to recurrent Clostridium difficile infection

SUMMARY A 78-year-old woman with long-standing obstipation presented herself to the hospital with diarrhoea and progressive abdominal cramping since 2 days. Acute abdomen developed and an emergency exploratory laparotomy was indicated, which showed no signs of bowel ischaemia. After admission to the internal ward, stool Clostridium difficile PCR was tested positive. Hence the diagnosis of pseudomembranous colitis became apparent. Abdominal imaging demonstrated multiple gas foci in the wall of the bladder and extensive pseudomembranous colitis. The patient was initially treated with oral vancomycin and secondarily with metronidazole for recurrent C. difficile infection. Resolution of diarrhoea and abdominal cramping was noted on 6-week follow-up visit. BACKGROUND Emphysematous cystitis (EC), characterised by air within the bladder wall, is a rare diagnosis. The underlying disease is usually caused by anaerobic bacteria. Prompt diagnosis and treatment are warranted to prevent the potential mortality of this infectious condition. Owing to increased use of radiological imaging, emphysematous conditions are more often diagnosed. Previous reports have described the association of Clostridium difficile infection to pneumatosis intestinalis. We present a patient with recurrent C. difficile infection that provoked pseudomembranous colitis-associated EC.