EpistemisPneumaturia
Specialty: Nephrology and urology.
Why it occurs
- Colovesical fistula (abnormal communication between the sigmoid colon and the bladder dome secondary to complicated diverticular disease)
- Rectovesical fistula (due to advanced colorectal or prostate neoplasia, or post-pelvic radiotherapy)
- Urinary tract infection due to gas-producing germs (cystitis or emphysematous pyelonephritis caused by Escherichia coli, Klebsiella pneumoniae or Clostridium, common in decompensated diabetics)
- Urogynecological fistula (communication with the vagina after complex hysterectomy or obstetric trauma)
Initial workup
Computed tomography (CT) of the abdomen and pelvis with oral and intravenous contrast, but without bladder contrast (test of choice to visualize intravesical gas bubbles and fistulous tracts); cystoscopy to locate the fistulous opening in the bladder wall; colonoscopy to rule out colon neoplasia as the origin of the fistula.
red flags
Pneumaturia associated with fever, chills, abdominal pain located in the left iliac fossa or generalized with signs of muscular defense (diverticular peritonitis or appendiceal perforation), or gas leakage along with fecal-like debris through the urethra.
Standard management
- Piperacillin/Tazobactam — 4.5 g every 6 hours intravenously in cases of emphysematous cystitis or sepsis of urinary origin
- Metronidazole — 500 mg every 8 hours orally or intravenously to provide anaerobic coverage if enterovesical fistula is suspected
- Resection surgery of the affected segment (definitive treatment in colovesical fistulas).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Nephrology and urology
- Listed causes
- 4
- Treatment options
- 3