Perforated emphysematous cystitis with widespread extraperitoneal gas and subcutaneous emphysema

Emphysematous cystitis (EC) is an uncommon urinary tract infection (UTI) characterized by proliferation of anaerobic bacteria in the bladder wall with subsequent intramural gas, which is considered pathognomonic (Wojack PR, Clin Imaging. 2020 Sep;65:1–4). It usually occurs in the elderly, with female predominance. The most important risk factor is diabetes mellitus, but it also happens in the setting of immunosuppression, neurogenic bladder, obstructive uropathy, and indwelling urinary catheter (Gunawardene MC, Int Surg J 2021;8:3441–3).