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When the abdomen misleads: Emphysematous pyelonephritis masquerading as pneumoperitoneum
Neel Swaminarayan1, Devesh Bhatia1, Mohammad Shazib Faridi1
1Department of Urology, Dr Baba Saheb Ambedkar Medical College and Hospital, Rohini, New Delhi, India.
Abstract:
A presentation in septic shock with tense abdominal distension and left flank pain, combined with a plain radiograph showing massive subdiaphragmatic free air usually suggests perforation of a hollow viscus. A CT scan obtained before laparotomy was undertaken, showing gas destroying the left renal parenchyma with extension into the pararenal space and rupture through the posterior parietal peritoneum with an intact gastrointestinal tract. Laparotomy was thus avoided; pneumoperitoneum is not always gastrointestinal in origin.
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