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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,036

Frequency: Monthly

ISSN 0375-9393

Online ISSN 1827-1596


Minerva Anestesiologica 2009 November;75(11):665-8


A case of fatal emphysematous pyelonephritis presenting as lower limb gaseous gangrene

Balicco B. 1, Manzoni D. 2, Ancora C. 3

1 Department of Anesthesia and Intensive Care, San Marco Polyclinic, Zingonia, Bergamo, Italy;
2 Department of Anesthesia and Intensive Care, San Marco Polyclinic, Zingonia, Bergamo, Italy;
3 Department of Radiology, San Marco Polyclinic, Zingonia, Bergamo, Italy

The aim of this paper was to focus on emphysematous pyelonephritis (EPN), which is a severe disease that is rarely described in intensive care literature, although it is well-considered in urology and radiology journals, with numerous case reports. A 61 year-old diabetic and obese woman admitted to the Intensive Care Unit (ICU) was diagnosed with gas gangrene of the left lower limb. Within a few hours, the patient needed mechanical ventilation and high inotropic support. The abdominal computed tomography (CT) scans showed bilateral renal calculi and gas within the renal parenchyma extending towards the lower limb. Despite aggressive antibiotic therapy, supportive intensive treatment and nephrectomy, the patient died after 5 days. EPN is a rare but severe disease whose early recognition is fundamental for a favorable outcome. Intensivists should reasonably suspect it whenever diabetic patients develop septic conditions and signs of gas collection in the abdomen, pelvis, retroperitoneal space or even in the lower limbs.

language: English


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