Free Air in the Abdomen
A 92-year-old woman was admitted to the hospital because of pain in the left lower quadrant of the abdomen, disorientation, and dehydration, with the presumed diagnosis of perforated sigmoid diverticulitis. She had lower abdominal peritoneal signs and elevated laboratory values suggesting infection (CRP 16.5 mg%, WBC 10.2/nL). Computerized tomography surprisingly revealed air inclusions in the bladder wall, without any air in the vesical lumen or the peritoneal cavity, i.e., pneumatosis vesicalis. A Foley catheter was inserted, and urine cultures were taken; these were positive for E.coli, and antibiotic treatment was begun with ciprofloxacin and metronidazole. The infectious laboratory values regressed under treatment, the patient’s mental state improved, and she was discharged from the hospital in good condition 12 days after admission. Pneumatosis vesicalis is a rare condition that can be caused not only by E. coli, but also by Klebsiella, Proteus, and staphylococci.
Felix K. Kiehn, Dr. med. Marc Höppner, Prof. Dr. med. Jörg Glatzle, Klinikum Konstanz, Klinik für Allgemein- und Visceralchirurgie, firstname.lastname@example.org
Conflict of interest statement
The authors state that they have no conflict of interest.
Translated from the original German by Ethan Taub, M.D.
Cite this as:
Kiehn FK, Höppner M, Glatzle J: Free air in the abdomen. Dtsch Arztebl Int 2017; 114: 446. DOI: 10.3238/arztebl.2017.0446