Gangrenous Cystitis: A Rare Case and Review of the Literature

Abstract

Background Gangrenous cystitis (GC) is an extremely rare urological emergency characterized by transmural bladder wall necrosis. Fewer cases have been documented in the literature over the past years. This report aims to present a fatal case of GC in a young woman without known comorbidities, potentially triggered by olanzapine-induced urinary retention. This case is accompanied by a review of the literature on similar cases to illustrate diagnostic pitfalls and highlight therapeutic approaches. Case presentation A 42-year-old female with no prior medical history, recently started on olanzapine for atypical depression, presented to the emergency department with altered mental status and signs of shock. Physical examination revealed abdominal distension and generalized rigidity. Urgent laparotomy revealed pan-peritonitis and full-thickness bladder necrosis. The patient was transferred to intensive care but died within 24 hours due to multi-organ failure. Histopathological examination showed transmural hemorrhagic necrosis with dense neutrophilic infiltration. Microbiological and neoplastic causes were ruled out. Clinical discussion GC is rarely seen today and is typically associated with diabetes, malignancy, or pelvic irradiation. In this case, no traditional risk factors were present. The anticholinergic effects of olanzapine likely led to silent urinary retention and bladder overdistension, resulting in ischemic necrosis. Similar iatrogenic cases have been sparsely described in the literature. Conclusion Gangrenous cystitis remains a diagnostic and therapeutic challenge. Clinicians should consider this diagnosis in patients presenting with acute abdomen and urinary symptoms, particularly when exposed to anticholinergic medications. Early recognition and intervention are essential to improve outcomes. Bangladesh Journal of Medical Science Vol. 25 No. 04 October’26 Page: 1366-1370