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Emphysematous Pyelonephritis Complicated by Sub Capsular Renal Hematoma: A Case Report

Received: 10 September 2020    Accepted: 27 September 2020    Published: 4 March 2021
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Abstract

Emphysematous pyelonephritis is a rare and serious life-threatening condition due to a fulminant infection of the urinary tract. It is most often seen in diabetics and is defined by the presence of gas in the renal parenchyma secondary to bacterial infection. We highlight an unusual presentation (extensive renal sub capsular hematoma) of this condition and detail diagnostic and management considerations, including choice of imaging modalities. We present the case of a 63-year-old woman admitted to the emergency room for the management of severe sepsis secondary to an emphysematous pyelonephritis complicated by a large subcapsular hematoma of the kidney having extended into the omental bursa. To our knowledge, this complication is unique and never has been reported in the literature. Surgical treatment was necessary to control this severe infection. The medical and surgical management of emphysematous pyelonephritis must be aggressive and well-coordinated, early diagnosis, antibiotics and assessment for operative intervention are essential. Diabetes is the principal risk factor as well as immunodepression. The prognosis remains poor of this serious infection. Sub capsular hematoma is unusual and a good parameter to assess the severity of this infection. The presence pf gas in the urinary tract is the sign of the presence of an active anaerobe infection.

Published in World Journal of Medical Case Reports (Volume 2, Issue 1)
DOI 10.11648/j.wjmcr.20210201.14
Page(s) 11-14
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Emphysematous Pyelonephritis, Diabetes, Subcapsular Hematoma, Omental Bursa

References
[1] Kaiser E, Fournier R. Pyélonéphrite emphysémateuse: diagnostic et traitement. Annales d’Urologie 2005, 39: 49–60.
[2] Wan YL, Lee TY, Bullard MJ, Tsai CC. Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome. Radiology 1996; 198 (2): 433–8.
[3] Kelly HA, MacCALLUM WG. PNEUMATURIA. JAMA 1898; XXXI (8): 375–81.
[4] Abdikarim HM, Hussein AM. Emphysematous pyelonephritis caused by candida species: A case report and outcome of 1-year follow-up. Urology Case Reports 30 (2020) 101113.
[5] Singh Ubee Sarvpreet, McGlynn Laura, Fordham Mark. Emphysematous pyelonephritis. BJU International. 2010; 107: 1474. https://doi.org/10.1111/j.1464-410X.2010.09660.x. BJU International.
[6] Jacobson SH, Ostenson CG, Tullus K, Brauner A. Serum resistance in Escherichia coli strains causing acute pyelonephritis and bacteraemia. APMIS 1992; 100 (2): 147–53.
[7] Wan YL, Lo SK, Bullard MJ, Chang PL, Lee TY. Predictors of outcome in emphysematous pyelonephritis. J Urol 1998; 159 (2): 369–73.
[8] Huang JJ, Tseng CC: Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med 2000, 160: 797–805.
[9] Ouellet LM, Brook MP: Emphysematous pyelonephritis: an emergency indication for the plain abdominal radiograph. Ann Emerg Med 1988, 17: 722–724.
[10] Chen Kuo-Chih, Hung Shih-Wen, SeowVei-Ken, Chong Chee-Fah, Wang Tzong-Luen, Li Yu-Chuan, et al. The role of emergency ultrasound for evaluating acute pyelonephritis in the ED. Am J Emerg Med 2011; 29 (7): 721–4.
[11] Gallardo X, Castañer E, Donoso L, Sentís M, Martín J, Bella R: CT diagnosis of renal subcapsular hematoma associated with emphysematous pyelonephritis. J Comput Assist Tomogr 1994, 18: 505–506.
[12] Olvera-Posada D, Armengod-Fischer G, Vázquez-Lavista LG, Maldonado-Ávila M, Rosas-Nava E, Manzanilla-García H, Castillejos-Molina RA, Méndez-Probst CE, Sotomayor M, Feria-Bernal G, Rodríguez-Covarrubias F: Emphysematous pyelonephritis: multicenter clinical and therapeutic experience in Mexico. Urology 2014, 83: 1280–1284.
[13] Min JW, Lee SK, Ko YM, Kwon KW, Lim JU, Lee YB, Lee HW, Won YD, Kim YO: Emphysematous pyelonephritis initially presenting as a spontaneous subcapsular hematoma in a diabetic patient. Kidney Research and Clinical Practice 2014, 33: 150–153.
[14] Asafu Adjaye Frimpong G, Aboagye E, Amankwah P, Boateng J, Amoako-Adu ASB. Bilateral emphysematous pyelonephritis cured by antibiotics alone in a black African woman. Radiol Case Rep. 2018; 13 (4): 848-854. Published 2018 Jun 26. doi: 10.1016/j.radcr.2018.05.018.
[15] Kuchay, M. S., Laway, B. A., Bhat, M. A. et al. Medical therapy alone can be sufficient for bilateral emphysematous pyelonephritis: report of a new case and review of previous experiences. Int Urol Nephrol 46, 223–227 (2014). https://doi.org/10.1007/s11255-013-0446-7.
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  • APA Style

    Ahmed Belkouch, Mustapha Nousair, Saad Zidouh, Rachid Sirbou, Said Jidane, et al. (2021). Emphysematous Pyelonephritis Complicated by Sub Capsular Renal Hematoma: A Case Report. World Journal of Medical Case Reports, 2(1), 11-14. https://doi.org/10.11648/j.wjmcr.20210201.14

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    ACS Style

    Ahmed Belkouch; Mustapha Nousair; Saad Zidouh; Rachid Sirbou; Said Jidane, et al. Emphysematous Pyelonephritis Complicated by Sub Capsular Renal Hematoma: A Case Report. World J. Med. Case Rep. 2021, 2(1), 11-14. doi: 10.11648/j.wjmcr.20210201.14

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    AMA Style

    Ahmed Belkouch, Mustapha Nousair, Saad Zidouh, Rachid Sirbou, Said Jidane, et al. Emphysematous Pyelonephritis Complicated by Sub Capsular Renal Hematoma: A Case Report. World J Med Case Rep. 2021;2(1):11-14. doi: 10.11648/j.wjmcr.20210201.14

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  • @article{10.11648/j.wjmcr.20210201.14,
      author = {Ahmed Belkouch and Mustapha Nousair and Saad Zidouh and Rachid Sirbou and Said Jidane and Lahcen Belyamani},
      title = {Emphysematous Pyelonephritis Complicated by Sub Capsular Renal Hematoma: A Case Report},
      journal = {World Journal of Medical Case Reports},
      volume = {2},
      number = {1},
      pages = {11-14},
      doi = {10.11648/j.wjmcr.20210201.14},
      url = {https://doi.org/10.11648/j.wjmcr.20210201.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjmcr.20210201.14},
      abstract = {Emphysematous pyelonephritis is a rare and serious life-threatening condition due to a fulminant infection of the urinary tract. It is most often seen in diabetics and is defined by the presence of gas in the renal parenchyma secondary to bacterial infection. We highlight an unusual presentation (extensive renal sub capsular hematoma) of this condition and detail diagnostic and management considerations, including choice of imaging modalities. We present the case of a 63-year-old woman admitted to the emergency room for the management of severe sepsis secondary to an emphysematous pyelonephritis complicated by a large subcapsular hematoma of the kidney having extended into the omental bursa. To our knowledge, this complication is unique and never has been reported in the literature. Surgical treatment was necessary to control this severe infection. The medical and surgical management of emphysematous pyelonephritis must be aggressive and well-coordinated, early diagnosis, antibiotics and assessment for operative intervention are essential. Diabetes is the principal risk factor as well as immunodepression. The prognosis remains poor of this serious infection. Sub capsular hematoma is unusual and a good parameter to assess the severity of this infection. The presence pf gas in the urinary tract is the sign of the presence of an active anaerobe infection.},
     year = {2021}
    }
    

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    T1  - Emphysematous Pyelonephritis Complicated by Sub Capsular Renal Hematoma: A Case Report
    AU  - Ahmed Belkouch
    AU  - Mustapha Nousair
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    JF  - World Journal of Medical Case Reports
    JO  - World Journal of Medical Case Reports
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    AB  - Emphysematous pyelonephritis is a rare and serious life-threatening condition due to a fulminant infection of the urinary tract. It is most often seen in diabetics and is defined by the presence of gas in the renal parenchyma secondary to bacterial infection. We highlight an unusual presentation (extensive renal sub capsular hematoma) of this condition and detail diagnostic and management considerations, including choice of imaging modalities. We present the case of a 63-year-old woman admitted to the emergency room for the management of severe sepsis secondary to an emphysematous pyelonephritis complicated by a large subcapsular hematoma of the kidney having extended into the omental bursa. To our knowledge, this complication is unique and never has been reported in the literature. Surgical treatment was necessary to control this severe infection. The medical and surgical management of emphysematous pyelonephritis must be aggressive and well-coordinated, early diagnosis, antibiotics and assessment for operative intervention are essential. Diabetes is the principal risk factor as well as immunodepression. The prognosis remains poor of this serious infection. Sub capsular hematoma is unusual and a good parameter to assess the severity of this infection. The presence pf gas in the urinary tract is the sign of the presence of an active anaerobe infection.
    VL  - 2
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Author Information
  • Emergency Department, Mohamed V Military Hospital of Instruction, Faculty of Medicine and Pharmacy, Mohammed V University, Hay Ryad, Rabat, Morocco

  • Emergency Department, Mohamed V Military Hospital of Instruction, Faculty of Medicine and Pharmacy, Mohammed V University, Hay Ryad, Rabat, Morocco

  • Emergency Department, Mohamed V Military Hospital of Instruction, Faculty of Medicine and Pharmacy, Mohammed V University, Hay Ryad, Rabat, Morocco

  • Emergency Department, Mohamed V Military Hospital of Instruction, Faculty of Medicine and Pharmacy, Mohammed V University, Hay Ryad, Rabat, Morocco

  • Emergency Department, Mohamed V Military Hospital of Instruction, Faculty of Medicine and Pharmacy, Mohammed V University, Hay Ryad, Rabat, Morocco

  • Emergency Department, Mohamed V Military Hospital of Instruction, Faculty of Medicine and Pharmacy, Mohammed V University, Hay Ryad, Rabat, Morocco

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