Editing Retroperitoneal abscess


Primary - haematogenous or lymphatic seeding from a distant site

Secondary - direct spread

== Risk factors ==

* Primary
** Diabetes
** IVDU
** HIV
** Immunosuppression
** Focal trauma and haematoma formation
* Secondary
** Infection in adjacent space
** Trauma and instrumentation

== Aetiology (mostly attributable to local renal/GIT disease) ==

* Primary (haematogenous spread)
* Secondary (infection in an adjacent organ)
** Renal disease
*** Pyelonephritis
*** Operations
** GIT disease
*** Appendicitis
*** Diverticulitis
*** Crohn disease
*** Pancreatitis
** Operative procedures
*** Epidural
** Bone infections of spine
*** TB


== Pathophysiology ==

* Causative organism depends on organ of origin
** Kidney - GNB
** GIT - polymicrobial
** Haematogenous - staph
** Spine - E coli or TB

== Presentation ==

* Classical triad - fever, back pain, and limp
* Abdominal/flank pain (60-75%)
* Fever and chills (30-90%)
* Malaise (10-20%)
* Weight loss (12%)
* Frequently present 1-2 weeks after start of symptoms

== Imaging ==

* Hypodense retroperitoneal mass
* Contains gas in 30%

== Natural history ==

* Stage 1 - insidious onset pain
* Stage 2 - pain develops and localises, systemic features develop
* Stage 3 - toxic sepsis

== Management ==

* Antibiotics - long course, 2-3 weeks on UTD
* CT-guided drainage (UTD says for all abscesses, successful 90%)
* OT for those that fail IR or are not amenable, due to multiloculated abscess, necrosis or something else requiring intervention
* Treat underlying cause

[[Category:Abdo wall and retroperitoneum]]