A 69-year-old woman with type 2 diabetes mellitus and hypertension presented to the emergency department with progressive right flank and right lower abdominal pain for 1 week. On examination, her bowel sounds were decreased. The abdomen was tender to palpation in the right lower quadrant, with no guarding or rebound. Right costovertebral angle percussion tenderness was also evident. Laboratory studies disclosed leukocytosis (41 x 109/L) in blood and pyuria (66 white blood cells per high-power field) on urinalysis. A radiograph of the abdomen revealed a large gas collection in the right abdomen, which was initially interpreted as colonic gas (Fig. 1). She was treated for acute pyelonephritis.
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机译：一名患有2型糖尿病和高血压的69岁妇女就诊于急诊科，患有进行性的右胁腹和右下腹痛1周。经检查，肠鸣音减弱。腹部触及右下腹触诊，无保护或反弹。右肋椎角per诊压痛也很明显。实验室研究显示，在尿液分析中，血液和脓尿（每个高倍视野中有66个白细胞）中有白细胞增多（41 x 109 / L）。腹部X光片显示右腹部有大量气体，最初被解释为结肠气体（图1）。她接受了急性肾盂肾炎治疗。
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