Pyocystis Causing Abdominal Wall Abscess and Necrotising Fasciitis

Pyocystis is a rare but known complication of the defunctioned bladder. We report a case of a female patient with long-term bilateral nephrostomies who was initially thought to have cystitis but later found to have pyocystis causing a vesicocutaneous fistula and an anterior abdominal wall abscess. It progressed to necrotising fasciitis, necessitating emergency drainage and debridement. This yielded 400 ml of pus, and she was found to have a defect in the anterior rectus sheath leading straight to the bladder. This report highlights the importance of maintaining a high index of suspicion for pyocystis in patients with a defunctioned bladder, and how delays in diagnosis and treatment can cause significant morbidity.