(Section Editor: G. H. Neild)

A 51-year-old woman with a history of diabetic uraemia under chronic haemodialysis presented with progressive low abdominal pain and dysuria for more than 1 week. She also had a low-grade fever with hypotension, and rap-idly progressed to septic shock. Physical examination showed marked tenderness in the suprapubic area. Labora-tory examination revealed that the white blood cell (WBC) count was 23 000 per cubic millimetre with segmented neu-trophils 88 % and band cells 10%. The urinalysis examina-tion showed pyuria with 40 white cells per high-power field. A plain abdominal radiograph showed severe dis-tended urinary bladder with diffuse cystic collections of gas within the urinary bladder wall (Figure 1A, arrows), and an abdominal computed tomographic scan helped con-firm the diagnosis of emphysematous cystitis by curvilinea