Emphysematous cystitis (EC) is a potentially fatal disease if treatment is delayed. A high index of suspicion is crucial for an early diagnosis of the disorder, which typically occurs in patients with poorly controlled diabetes. Although gas in the bladder is suggestive of EC, other differential diagnoses include a postoperative state, an enterovesical fistula and urological instrumentation. We report on a 73-year-old female diabetic patient who had undergone major surgery for an obstructive common bile duct stone 3 weeks prior to the onset of EC. She presented with an initial picture of severe sepsis, possibly due to a postoperative infection of the urinary and/or biliary tract. She responded well to prompt therapy with antibiotics, adequate drainage of the urinary and biliary tracts, and good glycemic control. She was discharged on hospital day 7 and remained stable during the 3-month follow-up period.
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