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Retroperitoneal abscess

From Surgopaedia

Primary - haematogenous or lymphatic seeding from a distant site

Secondary - direct spread

Risk factors

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  • 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)

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  • 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

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

Presentation

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  • 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

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  • Hypodense retroperitoneal mass
  • Contains gas in 30%

Natural history

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

Management

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  • 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
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