A rare cause of subcutaneous crepitation

A 66-year-old diabetic man presented with fever, hypotension, lower abdominal pain, hematuria and supra pubic crepitation. Abdominal CT scan revealed gas in bladder wall, and pre bladder space (Fig A), The patient was referred to the operating room where surgical findings confirmed bladder rupture requiring conservative surgery. Urine, blood cultures and operative samples grew with a cefotaxime sensitive Klebsiella pneumoniae gas producing strain (Fig B and C). The patient recovered progressively and was discharged from ICU six weeks later.