Retroperitoneal abscess after transanal minimally invasive surgery: case report and review of literature / Abscesso retroperitoneal após cirurgia de ressecção transanal minimamente invasiva: relato de caso clínico e revisão a literatura médica

ABSTRACT Abscesses are a rare complication of transanal minimally invasive surgery and transanal endoscopic micro surgery. Reported cases have been in the rectal and pre-sacral areas and have been managed with either antibiotics alone or in conjunction with laparotomy and diverting colostomy. We report a case of a large retroperitoneal abscess following a Transanal minimally invasive surgery full thickness rectal polyp excision. The patient was successfully managed conservatively with antibiotics and a percutaneous drain. Retroperitoneal infection should be included in a differential diagnosis following a Transanal minimally invasive surgery procedure as the presentation can be insidious and timely intervention is needed to prevent further morbidity.

RESUMO Os abscessos são uma complicação rara da cirurgia de ressecção transanal minimamente invasiva (TAMIS) e da micro cirurgia endoscópica transanal (TEMS). Os casos notificados foram nas áreas rectal e pré-sacral e foram administrados com antibióticos isoladamente ou em conjunto com laparotomia e desvio de colostomia. Relatamos um caso de grande abscesso retroperitoneal após uma excisão de pólipo retal de espessura total TAMIS. O paciente foi tratado com sucesso com a administração de antibióticos e drenagem percutânea. Para prevenir mais morbidade é necessária incluir a infecção retroperitoneal no diagnostico diferencial após um procedimento TAMIS onde a apresentação pode ser insidiosa e a intervenção atempada.

Abscesso retroperitoneal por corpo estranho / Retroperitoneal abscess by foreign body

Abscesso retroperitoneal é uma enfermidade infrequente e, muitas vezes, com sintomatologia inespecífica, o que torna difícil o diagnóstico. No presente trabalho é relatado o caso de um paciente masculino, 54 anos, previamente hígido, que apresentou lombociatalgia súbita, além de imagem suspeita na topografia de retroperitônio e, após piora clínica e laboratorial, necessitou-se de intervenção cirúrgica com o propósito diagnóstico e terapêutico (drenagem e retirada do corpo estranho descoberto no transoperatório). Objetivamos, com este relato, enfatizar é fundamental a suspeita clínica para se chegar ao diagnóstico e manejar corretamente essa patologia que, embora rara, deve ser reconhecida precocemente a fim de evitar desfechos fatais.

Retroperitoneal abscess is a rare disease, often with unspecific symptoms, which makes diagnosis difficult. In this paper we report the case of a previously healthy 54-year-old male patient who presented sudden low back pain, besides suspicious image on the retroperitoneal topography. After clinical and laboratory worsening, a surgical intervention was required for diagnostic and therapeutic purposes (drainage and removal of foreign body discovered trans-operatively). Our aim with this report is to stress that clinical suspicion is crucial to make the diagnosis and properly manage this condition which, although rare, should be recognized early in order to avoid fatal outcomes.

Retroperitonitis después de una apendicitis aguda no complicada / Retroperitonitis after an uncomplicated acute appendicitis

Se describe el caso clínico de un paciente de 27 años de edad, inmunocompetente operado sin dificultades de apendicitis aguda flegmonosa, en posición anterior, quien fue reintervenido en 2 ocasiones por retroperitonitis en forma de abscesos múltiples y se le realizaron 5 relaparotomías programadas para curas. Evolucionó favorablemente y egresó a los 36 días de la operación inicial, pero con seguimiento por consulta externa.

The case report of a 27 year immunocompetent patient, surgically treated without difficulties due to an acute flegmonous appendicitis, in anterior position who had 2 previous interventions due to retroperitonitis in form of multiple abscesses, and who had 5 scheduled relaparotomies for cures, is described. He had a favourable clinical course and he was discharged 36 days after the initial surgery, but under follow up through outpatient department.

Vía lumbar para plastrón apendicular abscedado / Lumbar route use for abscess appendicular plastron

Se presenta el caso de una paciente de 32 años de edad, con evolución tórpida desde el inicio de su enfermedad. Se intervino quirúrgicamente por presentar un plastrón apendicular abscedado. A pesar de que requirió 2 intervenciones, aparecieron signos flogísticos en la región lumbar derecha. Se practicó una lumbotomía y en la cavidad del absceso en el retroperitoneo se dejó un catéter para clisis de goteo rápido durante el posoperatorio. Luego se destechó dicha cavidad para cierre por segunda intención(AU)

This is a case presentation of a woman aged 32 with a torpid course from the onset of her disease. She was operated on due to an abscess appendicular plastron. Despite two surgical interventions there were weak signs in right lumbar zone. A lumbotomy was performed and in abscess cavity in retroperitoneum an indwelling catheter was placed for fast dripping clysis during the postoperative period. Then, this cavity was roofed off for second-look closure(AU)

Retroperitoneal Abscess in a Patient with Acute Appendicitis

Although acute appendicitis is one of the most common surgical diseases, very rare but serious complications can occur including retroperitoneal abscess complicated by acute appendicitis. The early diagnosis of retroperitoneal abscess is often difficult and delayed because its clinical course is often insidious and does not present with typical symptoms of acute appendicitis. We experienced a 65-year-old male patient who was diagnosed with acute appendicitis with retroperitoneal abscess. As the retroperitoneal abscess was not fully removed via emergency operation, postoperative percutaneous drainage was performed but not effective. Retroperitoneal abscess can be cured by 2nd operation with retroperitoneal approach. We report here an unusual case of retroperitoneal abscess complicated by acute appendicitis.

Endoscopic Drainage Through a Duodenal Fistula in a Patient with a Retroperitoneal Abscess that Developed after Acute Pancreatitis / 대한소화기내시경학회지

The incidence of retroperitoneal abscess with fistula formation after acute pancreatitis is rare, but the mortality rate for patients with this condition is very high. The standard treatment for this condition has been surgical removal and drainage. However, recent studies have shown that percutaneous catheter drainage or noninvasive endoscopic abscess drainage with using endoscopic ultrasonography is effective and safe for the treatment of pancreatic and peripancreatic abscess. A retroperitoneal abscess with duodenal fistula that developed after acute pancreas and its endoscopic treatment has never been reported on in Korea. We experienced a 45-year-old man who had been treated for acute pancreatitis at other hospital, and he was then referred to our hospital and diagnosed as having a retroperitoneal abscess with fistula, which communicated with the third portion of duodenum, as assessed by abdominal CT and duodenoscopy. So we treated him with endoscopic double-pigtailed stent insertion through the fistulous tract and we drained the abscess. Endoscopic drainage may be a suitable alternative for the management of the retroperitoneal abscess with fistula that develops after acute pancreatitis.

Retroperitoneal Abscess after Endovascular Repair of Infected Abdominal Aortic Aneurysm

Infected aneurysm of the aorta is a rare but life-threatening condition. The traditional strategy for treating infected aortic aneurysms is open surgical repair with antibiotic therapy. Endovascular repair of infected aortic aneurysms has been performed only sporadically. Case: A 70-year-old man with a history of diabetes who presented with intermittent fever for one month was referred to our institution. Before admission, antibiotic treatment had been already started and on admission, his general condition was not critical. A CT scan showed two saccular aneurysms of the infrarenal abdominal aorta and a retroperitoneal inflammation including hematoma. No microorganism was identified on blood culture. On follow-up CT scan 15 days later, a further increase in aneurysmal diameter was detected and endovascular repair was performed by using Gore Excluder stent graft. The patient was recovered and discharged on hospital day 29. One month after discharge, the patient was readmitted due to chilling and fever. Abdominal CT showed a retroperitoneal abscess around the previously repaired aortic aneurysm. Surgical drainage was performed without reconstruction with extra-anatomical bypass or in situ replacement. Culture from the abscess revealed the growth of Klebsiella pneumoniae. The patient was discharged on postoperative day 31 and continues to be observed.

Retroperitoneal Abscess after Endovascular Repair of Infected Abdominal Aortic Aneurysm

Infected aneurysm of the aorta is a rare but life-threatening condition. The traditional strategy for treating infected aortic aneurysms is open surgical repair with antibiotic therapy. Endovascular repair of infected aortic aneurysms has been performed only sporadically. Case: A 70-year-old man with a history of diabetes who presented with intermittent fever for one month was referred to our institution. Before admission, antibiotic treatment had been already started and on admission, his general condition was not critical. A CT scan showed two saccular aneurysms of the infrarenal abdominal aorta and a retroperitoneal inflammation including hematoma. No microorganism was identified on blood culture. On follow-up CT scan 15 days later, a further increase in aneurysmal diameter was detected and endovascular repair was performed by using Gore Excluder stent graft. The patient was recovered and discharged on hospital day 29. One month after discharge, the patient was readmitted due to chilling and fever. Abdominal CT showed a retroperitoneal abscess around the previously repaired aortic aneurysm. Surgical drainage was performed without reconstruction with extra-anatomical bypass or in situ replacement. Culture from the abscess revealed the growth of Klebsiella pneumoniae. The patient was discharged on postoperative day 31 and continues to be observed.

CT guided percutaneous drainage in treatment of solitary retroperitoneai abscess / 介入放射学杂志

Objective To evaluate the therapeutic efficacy of percutaneous drainage of solitary retroperitoneal abscess under CT guidance.Methods A retrospective analysis was made for percutaneous drainage of solitary retroperitoneal abscess with CT guidance in 13 patients including 4 at the tail of pancreas, 3 nearby the head of pancreas,3 in perirenal space,2 in posterior renal space and 1 case was by the side of psoas muscle.The maximum diameters of retroperitoneal abscess were between 3.5cm and 8cm.Results Out of 13 patients,8 with one time drainage,3 with twice drainages and 2 with thrice drainages.The mean duration of drainage was 16 days with no recurrence or residual lesions during clinical follow up.Conclusion CT guided percutaneous drainage of solitary retroperitoneal abscess is effective and minimally invasive.(J Intervent Radiol,2007,16:828-830)

Retroperitoneal Abscess by Citrobacter and Klebsiella in a Renal Transpant Recipient / 대한이식학회지

Infectious complications are common causes of morbidity in renal transplant recipients. To date, only two cases of retroperitoneal abscess caused by Norcardia asteroides and Mycobacterium fortuitum were reported in renal transplant recipients in the literature. We report a case of retroperitoneal abscess caused by gram negative bacilli-Citrobacter freundi, Klebsiella pneumoniae. The patient was admitted to the hospital due to flank pain. Abdominal CT scan and CT scan-guided aspiration confirmed retroperitoneal abscess. It is likely that the abscess in our patient was related to the anti-rejection treatment which included high-dose steroids, and mycophenolate mofetil. To our knowledge, this is the first report of retroperitoneal absces caused by gram-negative bacilli.

A Case of Glomerulonephritis Associated with Staphylococcal Retroperitoneal Abscess / 대한신장학회잡지

The development of renal glomerular lesions secondary to severe visceral infection (pulmonary, pleural, retroperitoneal or hepatic abscess) is not generally appreciated. Such patients resemble those with infective endocarditis. The suggested pathogenetic mechanisms by which infection can cause glomerular damage are immunologic interaction, direct toxicity of a bacterial products, and some other triggering factors; However, direct correlation between the infectious and immunologic events has not been demonstrated. The histopathologic findings of infectious glomerulonephritis are variable, and these findings, as well as the clinical abnormalities, may resolve with effective antimicrobial therapy or abscess drainage. We experienced a case of glomerulonephritis and acute renal failure due to staphylococcal retroperitoneal abscess. The patient was a 58-year-old man who presented with abdominal and back pain. We performed an abdominal CT scan which showed a retroperitoneal abscess which was proven to be a staphylococcal infection upon percutaneous abscess drainage. Furthermore, we performed a renal biopsy in order to investigate hematuria, RBC casts, and proteinuria. Pathologic findings revealed postinfectious glomerulonephritis. Abscess drainage and sensitive antibiotics were administered, after which his symptoms and urinary abnormalities disappeared, and the retroperitoneal abscess subsided. Here, we report a case of a staphylococcal retroperitoneal abscess which led to postinfectious glomerulonephritis and acute renal failure along with a brief review of the literatures.

Application of choledochoscope in drainage and adjunctive management of retroperitoneal abscess / 中国普通外科杂志

Objective To investigate the methods and effects of applying choledochoscope in drainage of retroperitoneal abscess.Methods Eighteen cases of retroperitoneal abscess,who underwent open surgical debridement and drainage or PCD but the drainage was ineffective,were selected for use of choledochoscope to irrigate and debride the abscess repeatedly.Results All of the 18 patients had effective choledoscopic treatment;in 17 patients the abscess healed and drainage catheter was successfully removed;but in one patient,who developed pancreatic fistula,was cured by internal drainage operation performed 6 months later.Conclusions Use of choledochoscope as an adjunctive treatment after drainage operation of retroperitoneal abscess is simple,safe,and effective.

Portal and superior mesenteric venous gas with retroperitoneal abscess: CT diagnosis (case report)

We present a case of portal and superior mesenteric venous gas in a 31-year-old diabetic woman with a left-sided retroperitoneal abscess. Five years prior to admission, patient was diagnosed with diabetes mellitus and developed emphysematous pyelonephritis, requiring nephrectomy on the left side. A CT examination showed air distributed throughout the portal venous system and superior mesenteric vein.