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An Enormous Gas-Filled Bladder
Vol. 116, December Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright © 1976 by The Williams & Wilkins Co.
AN ENORMOUS GAS-FILLED BLADDER J. F. CALDER
AND
P.
s.
ORR
From the Departments of Radiology and Urology, Victoria Infirmary, Glasgow, Scotland
ABSTRACT
A case of gaseous distension of the bladder without any obvious predisposing cause is reported. was pneumaturia a feature. In neither case could any organism be identified. The common predisposing factor in both cases appeared to be bladder neck obstruction. Therefore, it is concluded that in the presence of bladder neck obstruction,
Gas in the urinary tract, particularly the bladder, is uncommon. According to Senator gas in the bladder or urinary tract occurs 1) following instrumentation of the urogenital tract, 2) as a result of a fistula between the urogenital tract and the gastrointestinal tract and 3) as a result of fermentation with or without glycosuria. 1 More recently, additional causes have been recognized including infection, penetrating trauma and penetrating posterior wall duodenal ulcer. 2 Herein we report a case of a large gas-distended bladder without intramural gas in which none of the aforementioned criteria could be demonstrated. CASE REPORT
A 53-year-old male truck driver presented at the urological outpatient clinic with a 2-month history of painless hematuria. There were no other symptoms of the urinary or gastrointestinal tracts. The patient never had pneumaturia and no significant medical history was elicited. Examination revealed the abdomen to be distended by what was considered to be a large bladder. Urine culture yielded no growth and there was no clinical or biochemical evidence of diabetes mellitus. Blood urea was 45 mg. per 100 ml. and creatinine was 1.0 mg. per 100 ml. Excretory urography (IVP) revealed a large oval translucent area arising out of the pelvic cavity, which was considered to be a distended, gas-filled bladder (see figure). A lateral decubitus film showed a fluid level. No gas was seen in the bladder wall or elsewhere in the collecting system. A subsequent barium enema showed no abnormality and the chest radiogram was negative apart from showing old healed tuberculosis. Cystoscopy demonstrated a rather narrow urethra. There was an enormous urine residue amounting to several liters but the urine was clear and not infected. Marked rugosity of the bladder wall was present but there was no evidence of a fistula. The bladder was drained with an indwelling catheter and the patient was discharged from the hospital with the catheter in situ. Followup IVP and cystogram 4 months later showed no evidence of intraluminal gas but the bladder was still capable of considerable distension. The patient was totally unable to void when the catheter was removed but within a few days voiding was normal. He was free of symptoms when seen at the clinic 2 months later.
IVP shows considerable gaseous distension of bladder
gaseous distension of the bladder can occur without a history of pneumaturia and in the absence of any identifiable infection. Mr. L. S. Scott allowed us to publish this case.
DISCUSSION REFERENCES Gross gaseous distension of the bladder in a non-diabetic patient and in the absence of a fistulous communication with 1. Senator, H.: Cited by Alexander, J. C.: Pneumopyonephrosis in the bowel is rare. A similar case has been reported in which diabetes mellitus. J. Urol., 45: 570, 1941. none of the usual predisposing causes could be demonstrated. 3 2. Emmett, J. L. and Witten, D. M.: Clinical Urography, 3rd ed. Urinary retention with severe cystitis has been associated with Philadelphia: W. B. Saunders Co., p. 788, 1971. pneumaturia • but in neither our case nor that of Fetterman 3. Fetterman, L. E.: An unusually large gas-containing bladder. Brit.
Accepted for publication April 2, 1976.
J. Radio!., 45: 67, 1972. 4. Kent, H. P.: Gas in urinary tract. J. Fae. Radio!., 7: 57, 1955.
810
THE JOURNAL OF UROLOGY
Copyright © 1976 by The Williams & Wilkins Co.
AN ENORMOUS GAS-FILLED BLADDER J. F. CALDER
AND
P.
s.
ORR
From the Departments of Radiology and Urology, Victoria Infirmary, Glasgow, Scotland
ABSTRACT
A case of gaseous distension of the bladder without any obvious predisposing cause is reported. was pneumaturia a feature. In neither case could any organism be identified. The common predisposing factor in both cases appeared to be bladder neck obstruction. Therefore, it is concluded that in the presence of bladder neck obstruction,
Gas in the urinary tract, particularly the bladder, is uncommon. According to Senator gas in the bladder or urinary tract occurs 1) following instrumentation of the urogenital tract, 2) as a result of a fistula between the urogenital tract and the gastrointestinal tract and 3) as a result of fermentation with or without glycosuria. 1 More recently, additional causes have been recognized including infection, penetrating trauma and penetrating posterior wall duodenal ulcer. 2 Herein we report a case of a large gas-distended bladder without intramural gas in which none of the aforementioned criteria could be demonstrated. CASE REPORT
A 53-year-old male truck driver presented at the urological outpatient clinic with a 2-month history of painless hematuria. There were no other symptoms of the urinary or gastrointestinal tracts. The patient never had pneumaturia and no significant medical history was elicited. Examination revealed the abdomen to be distended by what was considered to be a large bladder. Urine culture yielded no growth and there was no clinical or biochemical evidence of diabetes mellitus. Blood urea was 45 mg. per 100 ml. and creatinine was 1.0 mg. per 100 ml. Excretory urography (IVP) revealed a large oval translucent area arising out of the pelvic cavity, which was considered to be a distended, gas-filled bladder (see figure). A lateral decubitus film showed a fluid level. No gas was seen in the bladder wall or elsewhere in the collecting system. A subsequent barium enema showed no abnormality and the chest radiogram was negative apart from showing old healed tuberculosis. Cystoscopy demonstrated a rather narrow urethra. There was an enormous urine residue amounting to several liters but the urine was clear and not infected. Marked rugosity of the bladder wall was present but there was no evidence of a fistula. The bladder was drained with an indwelling catheter and the patient was discharged from the hospital with the catheter in situ. Followup IVP and cystogram 4 months later showed no evidence of intraluminal gas but the bladder was still capable of considerable distension. The patient was totally unable to void when the catheter was removed but within a few days voiding was normal. He was free of symptoms when seen at the clinic 2 months later.
IVP shows considerable gaseous distension of bladder
gaseous distension of the bladder can occur without a history of pneumaturia and in the absence of any identifiable infection. Mr. L. S. Scott allowed us to publish this case.
DISCUSSION REFERENCES Gross gaseous distension of the bladder in a non-diabetic patient and in the absence of a fistulous communication with 1. Senator, H.: Cited by Alexander, J. C.: Pneumopyonephrosis in the bowel is rare. A similar case has been reported in which diabetes mellitus. J. Urol., 45: 570, 1941. none of the usual predisposing causes could be demonstrated. 3 2. Emmett, J. L. and Witten, D. M.: Clinical Urography, 3rd ed. Urinary retention with severe cystitis has been associated with Philadelphia: W. B. Saunders Co., p. 788, 1971. pneumaturia • but in neither our case nor that of Fetterman 3. Fetterman, L. E.: An unusually large gas-containing bladder. Brit.
Accepted for publication April 2, 1976.
J. Radio!., 45: 67, 1972. 4. Kent, H. P.: Gas in urinary tract. J. Fae. Radio!., 7: 57, 1955.
810