Title: Emphysematous Pyelonephritis with Extensive Myonecrosis: A Case Report
Authors: Rajesh G. Halarnakar, Prashant T.N. Mandrekar, Pankaj D. Chari, Veku A. Gaude, Maria Amanda L. Cardoso, Nilesh B. Talwadker, Prashant R. Lawande, Madhumohan R. Prabhudessai
DOI: https://dx.doi.org/10.18535/jmscr/v7i12.53
Abstract
Emphysematous pyelonephritis (EPN) is a urologic emergency characterized by an acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens. This is a case report of a 60 year old female who presented to Goa Medical College with lower abdominal pain, vomiting and inability to walk. On CT scan patient was diagnosed to have bilateral emphysematous pyelonephritis with extension of air into posterior abdominal wall, right gluteal region and right thigh. On examination patient had tenderness in both lumbar and suprapubic region with crepitation over right lower abdomen, back, right gluteal region and right thigh. CT scan revealed bilateral emphysematous pyelonephritis with extension of air into the pelvis, posterior abdominal wall, right gluteal region and right thigh. Blood tests showed leucocytosis with thrombocytopenia with arterial blood gas analysis showing metabolic acidosis. Emergency percutaneous nephrostomy was done bilaterally. Patient subsequently underwent cystocopy with Right DJ Stenting with Left nephrectomy with desloughing and release incision of right buttock, back & right thigh. Bilateral EPN with extensive myonecrosis is a rare and extremely serious, life threatening condition requiring aggressive management. Aggressive management is needed in the form of wide desloughing and nephrectomy.
Keywords: Emphysematous pyelonephritis, myonecrosis, nephrectomy
