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An Unexpected Complication After Extracorporeal Shock Wave Lithotripsy: Emphysematous Pyelitis
Kamil Gokhan Seker1, Yusuf Arikan1, Yurdagul Cetin Seker2
1Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TUR.
Cureus
|July 2, 2020
Summary
Emphysematous pyelitis (EP), a severe urinary tract infection, can rapidly develop after extracorporeal shock wave lithotripsy (ESWL). Prompt diagnosis via non-contrast CT is crucial for timely intervention in patients presenting with fever and flank pain post-ESWL.
Area of Science:
- Urology
- Infectious Diseases
- Radiology
Background:
- Emphysematous urinary tract infections (UTI) are severe conditions caused by gas-forming bacteria.
- Emphysematous pyelitis (EP) specifically involves gas within the renal collecting system, a rare but critical complication.
- Extracorporeal shock wave lithotripsy (ESWL) is a common procedure for kidney stones.
Observation:
- An 81-year-old female with hypertension underwent ESWL for a left renal pelvic stone.
- Within 10 hours post-ESWL, she presented with fever and left flank pain.
- Non-contrast computed tomography (NCCT) revealed gas in the left renal collecting system, confirming EP.
Findings:
- The patient was diagnosed with emphysematous pyelitis (EP) shortly after ESWL.
- Treatment included broad-spectrum antibiotics and nephrostomy catheter placement.
- The case highlights a rapid onset of EP following ESWL.
Implications:
- EP must be considered in patients with fever and flank pain after ESWL.
- Urgent NCCT is essential for diagnosing gas formation in the renal collecting system.
- Rapid diagnosis and management in the emergency department are critical for patient outcomes.
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