Abstract
INTRODUCTION: Emphysematous cystitis (EC) is a rare anaerobic bacterial infection, often linked to diabetes, neurogenic bladder, or radiotherapy. Severe cases can weaken the bladder wall, causing spontaneous rupture, which may be intra- or extraperitoneal. While conservative treatment with drainage and antibiotics is possible, intraperitoneal rupture requires surgery to prevent septic shock. PRESENTATION OF CASE: A 61-year-old dialysis-dependent patient with a history of lumbotomy for renal calculus and type 2 diabetes was admitted for confusional syndrome and shock. Workup showed inflammatory syndrome, renal failure, and purulent urine. Imaging revealed EC with a retro vesical abscess and suspected bladder rupture. Surgical exploration confirmed spontaneous intraperitoneal bladder rupture with necrosis. Debridement, bladder suturing, cystostomy, and drainage were performed. DISCUSSION: EC is a rare bladder infection characterized by gas accumulation, primarily associated with diabetes. It is caused by facultative anaerobes such as E. coli and Klebsiella pneumoniae. EC can range from asymptomatic to severe, potentially leading to spontaneous intra- or extraperitoneal bladder rupture, a rare but life-threatening complication. CT scans are the gold standard for diagnosis. Treatment of uncomplicated EC includes broad-spectrum antibiotics, bladder drainage, and glycemic control. Severe cases, especially intraperitoneal rupture, may require surgical intervention. CONCLUSION: EC is a rare but severe bladder infection with a misleading presentation, which can delay diagnosis. If left untreated, it may lead to life-threatening complications such as bladder rupture and septic shock, requiring immediate surgical intervention. Our goal is to identify key diagnostic features that facilitate the early detection and effective management of emphysematous cystitis, preventing severe complications.