Emphysematous pyelocystitis in a renal allograft secondary to sigmoid diverticular disease and colovesical fistula: a case report

摘要

Pyelonephritis is a serious common complication of transplantation that can lead to either acute renal failure or graft loss. The occurrence of diverticulitis in a renal transplant recipient is a rare complication but may lead to major morbidity and mortality. The overall incidence of diverticular disease in patients over the age of 60 years is 30%. Intense immunosuppression plays a major role in the development of infection during the first 6 months after transplantation. This may take the form of emphysematous pyelonephritis due to gas-forming organisms, xanthogranulomatous nephritis and malacoplakia. The incidence of colonic perforation secondary to diverticulitis in renal transplant patients is 0.9%. Emphysematous cystitis and pyelitis affecting a renal transplant allograft is a rare but serious condition and patients with diabetes mellitus, neurogenic bladder, bladder outlet obstruction, and recurrent urinary tract infections (UTIs) are at increased risk for the disease. In this case, severe urinary sepsis culminated in disseminated intravascular coagulation involving the mesenteric vessels leading to ischaemic infarction of the midgut which proved fatal. In non-diabetic patients with pneumaturia and recurrent UTIs, inflammatory enterovesical communication should be suspected and investigation by computed tomography and the institution of appropriate treatment is indicated.