Summary

An 86-year-old woman with type 2 diabetes was admitted with increasing lethargy and hyperglycaemia. On examination she was noted to have a tender and tympanic bladder. CT revealed a distended bladder with gas locules in the bladder wall. She was diagnosed with hyperglycaemic hyperosmolar non-ketosis precipitated by emphysematous cystitis. After systemic antibiotics and bladder drainage via a urethral catheter, her symptoms readily improved. Radiographic appearances of the bladder were normal one week after instigating treatment. Emphysematous cystitis is characterized by gas within the bladder wall. Although rare it is increasingly more recognized with the advent of modern imaging. The mainstay of treatment is antibiotics and bladder drainage. Rarely surgical debridement and even cystectomy is required.