This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Citing articles on Web of Science (10)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

An Unusual Cause of Pneumoperitoneum

Lorrie A. Langdale, MD; Charles L. Rice, MD; Nancy Brown, MD

Arch Surg. 1988;123(3):377-379.

Abstract
• Emphysematous pyelonephritis is a rare, life-threatening suppurative infection of the renal parenchyma and perinephric tissues. The disease is encountered primarily in patients with diabetes mellitus or ureteral obstruction associated with perinephric and intrarenal gas. Causative organisms are those normally found in the urinary and gastrointestinal tracts; however, anaerobic bacteria have been demonstrated in only 1% of cases. We describe a case of emphysematous pyelonephritis, which presented as an acute abdomen with pneumoperitoneum in a nondiabetic patient. No visceral injury was found at laparotomy. Multiple gas-producing organisms, including Clostridium ramosum (not previously reported, to our knowledge), were the cause of the free intraperitoneal and perinephric air. Subsequent radical nephrectomy revealed a xanthogranulomatous kidney. An aggressive surgical approach combined with intensive antibiotic therapy, after aerobic and anaerobic culture of excised tissue, is lifesaving.

(Arch Surg 1988;123:377-379)

Author Affiliations
From the Departments of Surgery (Drs Langdale and Rice) and Radiology (Dr Brown), Michael Reese Hospital and Medical Center, Chicago. Drs Langdale and Rice are now with the Department of Surgery, University of Washington, Seattle.

Footnotes
Accepted for publication Feb 23, 1987.

Presented at the Washington Chapter Meeting of the American College of Surgeons, Salishan, Ore, June 24, 1986.

Reprint requests to the Department of Surgery, Room 250, Veterans Administration Medical Center, 1660 S Columbian Way, Seattle, WA 98108 (Dr Langdale).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Necrotizing Fasciitis Caused by Xanthogranulomatous and Emphysematous Pyelonephritis: Importance of the Inferior Lumbar Triangle Pathway
Ishigami et al.
Am. J. Roentgenol. 2004;183:1708-1710.
FULL TEXT  

Spondylodiscitis Due to Clostridium ramosum Infection in an Immunocompetent Elderly Patient
Lavigne et al.
J. Clin. Microbiol. 2003;41:2223-2226.
ABSTRACT | FULL TEXT