Emphysematous Cystitis - Symptoms, Diagnosis, and Treatment

What Is Emphysematous Cystitis?

Emphysematous cystitis is an uncommon form of complicated urinary tract infection; it is characterized by the presence of gas within the lumen and bladder wall. Emphysematous cystitis is not subjected to age predisposition or gender. Diabetes mellitus is the most common risk factor that can lead to this condition. This condition is also more common in cows, cats, and dogs. Emphysematous cystitis is an inflammatory disease of the bladder resulting from a gas-producing bacterial infection.

What Is Crohns Disease?

Crohn’s disease is a type of inflammatory bowel disease that causes infection and inflammation in the digestive tract, leading to severe diarrhea, weight loss, fatigue, abdominal pain, and malnutrition. Inflammation due to this condition can involve many areas of the digestive tract and can spread to the deeper layers of the bowel. It is a painful and debilitating condition and can lead to life-threatening complications.

What Is the Prevalence of Emphysematous Cystitis with Crohns Disease?

There is multiple evidence of emphysematous cystitis with infectious colitis, both with or without microbiological evidence. Acute colonic inflammation that results from diverticulitis has also been associated with the presence of emphysematous cystitis. In some cases, fistula formation between the colonic diverticula and bladder has an association with emphysematous cystitis.

Crohn’s disease is a systemic relapsing inflammatory disease that affects any segment of the gastrointestinal tract and can result in complications like strictures, fistula formation, and fibrosis. Crohn’s colitis presents as segmental inflammation or transmural that is restricted to the colon, but some individuals do exhibit symptoms and features of the perianal disease and extraintestinal manifestations. Emphysematous cystitis is an unappreciated sign of severe Crohn’s disease that should be further investigated.

What Are the Signs and Symptoms of Crohns Disease?

The signs and symptoms of Crohn's disease are:

• Nausea.

• Vomiting.

• Abdominal pain.

• Fever.

• Fatigue.

• Blood in stool.

• Mouth sores.

• Pain in a drainage near the anus due to inflammation.

• Reduced appetite and weight loss.

• Iron deficiency.

• Flatulence.

• Icterus.

• Heartburn.

• Rectal bleeding.

• Ulcer formations.

• Dyspepsia.

• Constipation.

How Is the Diagnosis Done for Crohns Disease and Evident Emphysematous Cystitis?

• CT Scan (Computed Tomography Scan): An enhanced CT scan of the chest, pelvis, and abdomen is done. This helps in the identification of any circumferential mural thickening of the colon with multiple pseudopolyps.

• Pelvic MRI (Magnetic Resonance Imaging): This helps in ruling out any fistulating disease.

• Cystoscopy: A flexible cystoscopy with a CT cystogram is used to reveal patchy areas of submucosal hemorrhage throughout the posterior bladder wall.

• Colonoscopy: A thin, flexible camera-headed tube is used in this procedure to examine the ulcerated areas and suspicious areas of the colon.

• Colonic Biopsies: Colonic biopsies confirm the diagnosis of Crohn's disease with its presence of connection with dysplasia or granulomata. In most cases, there is no evidence.

• Culture Tests: Culture tests are done on the drained fluids to identify the infectious organisms responsibly.

• Blood Tests: Blood tests are done to check the elevated values of the WBC (white blood cells) and other ranges of blood contents.

How Is Emphysematous Cystitis a Potential Marker of Severe Crohns Disease?

• Emphysematous cystitis is a setting of infectious colitis. There is evidence of associated type 2 diabetes mellitus in patients with this condition. The presence of emphysematous cystitis with a UTI (urinary tract infections) is not very common.

• The association between emphysematous cystitis and colonic inflammation is poorly understood. A possible explanation of bacterial translocation within the abdomen from the disruption of the mucosal barrier or secondary to chronic inflammation. Similar mechanisms are seen in severe irritable bowel disease.

• Whether bacterial translocation is a consequence or cause of intestinal inflammation, irritable bowel disease has a high rate of bacterial DNA in blood samples.

• Severe Crohn's colitis can also cause emphysematous changes within the bowel wall. Emphysematous cystitis is a severe complication of the colonic inflammatory process.

• Emphysematous cystitis can be a potential marker in severe cases of emphysematous Crohn’s disease, and these can lead to poor prognostic conditions of the individuals.

What is the Treatment given for Crohns Disease?

There is no current cure for Crohn’s disease, the goal of the treatment is to reduce inflammation that would trigger the signs and symptoms, and the other goal is to improve the prognosis and limit complications.

Treatment for Crohn's disease includes:

• Anti-inflammatory Drugs: Drugs are always the first choice in cases of inflammation.

  • Corticosteroids: Prednisone and Budesonide can help reduce inflammation.

  • Oral Five Aminosalicylates: Drugs include Sulfasalazine, sulfa, and Mesalamine. ORAL 5 - aminosalicylates are widely used with limited benefit.

• Immune System Suppressors: These drugs target the immune system and reduce inflammation.

  • Azathioprine and Mercaptopurine: Most widely used immunosuppressants for treating inflammatory bowel disease.

  • Methotrexate: These drugs are used in individuals who do not respond well to other medications.

• Biologics: The class therapies that target proteins made by the immune system used to treat Crohn's disease are replaced with the colon.

  • Natalizumab and Vedolizumab: These drugs work by hindering certain immune cell molecules - by binding to other cells of the intestinal lining.

  • Infliximab, Certolizumab Pegol: TNF inhibitors work by neutralizing the immune system.

  • Ustekinumab: They work by interfering with the action of interleukin.

• Antibiotics: Drugs frequently prescribed are Ciprofloxacin and Metronidazole.

• Other Medications: Over-the-counter drugs like antidiarrheals, pain relievers, vitamins, and supplements are prescribed.

• Nutritional Therapy: A special diet is given by feeding tube or mouth. This can help in improving overall nutrition. A lower fiber diet is used to reduce the risk of intestinal blockage, which can help reduce the size and number of stools.

• Surgery: If drug therapy, other treatments, diet, and lifestyle changes do not relieve the symptoms, surgery is recommended. During this procedure, the damaged part of the digestive tract is removed. Surgeries to close fistulas and drain abscesses can also be performed.

The benefits of surgery for Crohn’s disease are temporary, and following surgery with medication is required to minimize the risk of recurrence.

Conclusion:

Emphysematous cystitis is a complicated urinary tract infection that presents with severe clinical sequelae, defined by the presence of gas in the bladder wall. Along with ascending infection by gas-producing organisms, this can also result from pelvic or abdominal instrumentation, fistula to a hollow viscus, and infarction of tissues with necrosis. Concomitant erythematous cystitis in decompensated Crohn's disease individuals may be a marker of severe inflammation that can lead to poor prognosis.