Retroperitoneal ascariasis: A case report

@#Infection with adult Ascaris primarily occurs in the gastrointestinal system, but physical migrationother than this has been reported. To date, only a small number of cases have been reported to involvethe urinary system and no report of Ascariasis migration to the retroperitoneal space.This is a case of a 38-year-old female admitted as a case of perinephric abscess, renal mass right.Patient was initially managed conservatively with broad spectrum antibiotics and tube drainage, butwith the deteriorating condition, an exploratory laparotomy, with retroperitoneal exploration wasdone. During exploration, no colonic fistula was noted. The renal parenchyma was noted to bepinkish with a 1cm opening at the mid lateral pole associated with purulent discharge. Interestingly,a 6cm x 1cm wax-like, moving structure was found in the retroperitoneal space The object wasremoved with Debakey forceps and was determined to be Ascaris lumbricoides by histopathology.Fecal analysis of stool for ova and parasites was negative for Ascaris. The patient then had an uneventfulrecovery.Currently, there are only two theories on how Ascaris lumbricoides can be introduced into the urinarysystem. The first includes fistulation between the GI and urinary system and second by retrogrademigration of the adult worm through the urethra. Given the current data, the authors believe that thepatient experienced retrograde invasion of Ascaris through the urethra, and subsequently migrated tothe retroperitoneal space through fistulation.Ascariasis of the genitourinary tract is a rare condition. This is the first reported case of ascariasis inthe retroperitoneum.

Clinical analysis of the drainage of perinephric abscess with retroperitoneal laparoscopy / 中华泌尿外科杂志

Objective To discuss the safety and effectiveness of the drainage of perinephric abscess with retroperitoneal laparoscopy.Methods The clinical data of 12 cases undergoing the drainage of perinephric abscess with retroperitoneal laparoscopy were analyzed retrospectively.There were 3 males and 9 females,with a mean age of 47 years.All the 12 cases presented with lumbar pain and fever,7 cases had chill,5 cases had irritative symptom of bladder,and 4 cases had nausea and vomiting.The average course was 9 d,and the average diameter was 6.4 cm.Four cases were in the left side,and 8 in the right side.The main complications included type-2 diabetes (5 cases),type-1 diabetes (1 case),kidney stones (2 cases) and systemic lupus erythematosus (1 case).All the 12 cases were treated with antibiotics.The indexes were recorded,including operative time,intraoperative blood loss,purulent fluid volume,postoperative indwelling time of the drainage tube,postoperative time of body temperature returned to normal,postoperative hospital stay,and complication rate.Results All the 12 operations were successful without peritoneal damage,kidney damage or other complications.The mean operative time was 56 (48-95) min,the mean intraoperative blood loss was 127 (60-150) ml,the mean intraoperative purulent fluid volume drawed out was 128 (120-230) ml,the mean postoperative indwelling time of the drainage tube was 9 (6-12) d,the mean postoperative time of body temperature returned to normal was 3 (2-4) d,and the mean postoperative hospital stay was 10 (7-12) d.All the patients were followed up for an average of 6.5 (6-12) months,no recurrence occured.Conclusions The drainage of perinephric abscess with retroperitoneal laparoscopy has the advantages of definite effectiveness,complete drainage,little injury and rapid recovery.The drainage of perinephric abscess with retroperitoneal laparoscopy by skilled urologists is safe.

Perinephric abscess caused by fusarium chlamydosporum in an immunocompetent child: Case report and identification of the morphologically atypical fungal strain.

Fusarium infections are important problem worldwide, cause a broad spectrum of infections in human including superfi cial infections as well as locally invasive and disseminated infections. We report a rare case of perinephric abscess caused by Fusarium chlamydosporum in a child who had a recent episode of pyelonephritis. This case illustrates the ever increasing spectrum of rare but offending pathogenic fungi in an immunocompetent host. Fungal infections should always be suspected in patients having one or the other underlying risk factor or who are unresponding to antibacterial therapy. Early diagnosis of infection with a specifi c pathogen may lead to changes in antifungal therapy and may be critical for an improved outcome

Abscesos renales y peri-renales: análisis de 44 casos / Renal and perinephric abscesses: a series of 44 cases

Renal abscesses are infrequent event and may occasionally be fatal. In order to characterize its main clinical features, its diagnosis and evolution, a retrospective-descriptive study was done with cases identified between 1996 and 2006 in a teaching hospital. Forty-four cases were collected (mean age 49.9 years). Diabetes mellitus was present in 38.6 percent, urinary calculi in 36.4 percent, and previous urinary tract infection in 11.4 percent of the studied population. Enterobacteriaceae were the most frequent isolated microorganisms (44.4 percent), and 33.3 percent had a poli-microbial culture in abscess samples. S. aureus was rarely identified. Main therapeutic approaches were minimally invasive procedures (pigtails, percutaneous drainage or nephrostomy) in 50 percent followed by surgical interventions (nephrectomy or surgical debridement) in ~30 percent. Only 20.5 percent of patients were treated exclusively by antibiotics. Minimally invasive procedures were applied progressively after 2001 (p < 0.005). In this series case-fatality rate was 4.5 percent; 13.6 percent (n = 6) developed septic shock. Nephrectomy was performed in 9 cases (20.5 percent). Patients selected for nephrostomy had a lower risk for ICU admission (Odds Ratio 0.083 IC95 0.008-0.911). Renal abscesses are cause of morbidity but had a low case-fatality ratio; the therapeutic approach has changed in recentyears favoring at present minimally invasive procedures.

Los abscesos renales son eventos infrecuentes pero potencialmente letales. Objetivo: Conocer sus características clínicas, diagnóstico y evolución. Metodología: Se efectuó un trabajo descriptivo-retrospectivo con los casos detectados entre 1996 y el 2006 en un centro universitario. Resultados: Se identificaron 44 pacientes (edad promedio 49,9 años) asociados en algunos casos a diabetes mellitus (38,6 por ciento), litiasis urinaria (36,4 por ciento) o infección urinaria previa (11,4 por ciento). Los microorganismos más frecuentes fueron Enterobacteriaceae (44,4 por ciento) y 33,3 por ciento> de los cultivos fueron polimicrobianos. Staphylococcus aureus se identificó infrecuentemente. La estrategia terapéutica principal fue el uso de técnicas mínimamente invasoras (pigtails, drenaje percutáneo o nefrostomía; 50 por ciento), y luego quirúrgicas (nefrectomía o aseos quirúrgicos; ~30 por ciento>). Sólo 20,5 por cientoo fue tratado exclusivamente con antimicrobianos. Los procedimientos mínimamente invasores se usaron en forma progresiva después del 2001 (p < 0,005). La letalidad en esta serie fue 4,5 por ciento> (n = 2) y 13,6 por ciento (n = 6) desarrolló shock séptico. La nefrectomía se aplicó en 9 casos (20,5 por ciento). Los pacientes seleccionados para nefrostomía tuvieron menos riesgo de ingresar a UCI (Odds Ratio 0,083 IC95 0,008-0,911). Conclusiones: Los abscesos renales son causa de morbilidad mayor aunque de baja letalidad. Su estrategia terapéutica ha ido cambiando en los últimos años a favor de procedimientos mínimamente invasores como los drenajes percutáneos y/o endoscópicos.

A perinephric abscess caused by Streptococcus agalactiae / 대한내과학회지

Group B streptococcus (GBS, Streptococcus agalactiae) has recently been recognized as an important, increasingly common cause of invasive disease in non-pregnant adults with underlying medical conditions. Diabetes mellitus, malignancies, liver cirrhosis, and previous trauma history increase the risk for invasive GBS disease. We report a rare case of perinephric abscess caused by GBS in a non-pregnant diabetic woman. A 24-year-old woman with diabetes and a history of urinary tract infection presented with a 4-week history of intermittent febrile sensation, chills, right flank pain, and anorexia. Computed tomography revealed an 8-cm right perinephric abscess. She was treated with percutaneous drainage of the abscess and intravenous antibiotics directed at the GBS, which had grown from the abscess drainage. She had a satisfactory clinical course.

A Case of Perinephric Abscess Treated by Percutaneous Drainage

Perinephric abscess is an accumulation of pus in the perinephric space, the area anatomically defined between the kidney and Gerota's fascia. Gram negative organisms are the most prevalent bacterial species found in perinephric abscess. Fever, flank pain, vomiting and abdominal mass are the usual presenting complaints. But with its insidious onset, variable symptoms and rare frequency in children, perinephric abscess has been a major diagnostic problem, leading to delayed diagnosis and inappropriate treatment, which increase the rate of complication and mortality. Clinical diagnosis of perinephric abscess is difficult but must always be considered in children with a febrile septicemic illness. For appropriate treatment, early detection is very important, and either ultrasonography or computed tomography(CT) facilitates the diagnosis and establishment of treatment method. We experienced a case of left perinephric abscess treated by percutaneous drainage in a 1-year 7-month old boy. Review of literature was made briefly.

A Case of Term Delivery in Patient with Perirenal Abscess / 대한산부인과학회잡지

Acute abdominal pain during pregnancy may be urologic origin. In this report, perinephric abscess was treated by percutaneous catheter drainage until a term delivery was achieved. We have experienced a case of perinephric abscess of pregnancy and reported with brief review of related literatures.

A Clinical Survey on Renal and Perinephric Abscess / 대한비뇨기과학회지

Renal and perinephric abscess are uncommon entities with a multitude of clinical presentations. Delay in diagnosis and treatment contributes to the high morbidity and mortality rate in the past. Recently, the introduction of newer imaging modalities, such as ultrasonography and CT scanning, has allowed accurate diagnosis and treatment. We reviewed retrospectively 12 cases of renal or perinephric abscess who were admitted to the National Medical Center during the period from January, 1981 to January, 1991. The following results were observed. 1. Among 12 patients, 7 patients were women and 5 patients were men and their age ranged from 11 to 59 years old with mean of 34 years. In 9 cases, the right kidneys were involved and in 3 cases, the left kidneys were involved. 2. On laboratory findings, 5 cases(42%) of pyuria and 1 case(8%) of positive urine culture and 11 cases(92%) of leukocytosis were seen. 3. Among 10 cases performed pus culture, causative organism was recovered in 8 cases: Gram-positive coccus in 5 cases and Gram-negative rod in 3 cases. 4. Urologic underlying diseases were identified in 5 cases and non-urologic associated diseases were in 5 cases. 5. Among 12 cases, 2 cases were treated by antibiotics only, 1 case was treated by nephrectomy, 4 cases underwent open drainage and 5 cases were managed successfully by closed drainage.

Clinical Observation on Renal and Perinephric Abscess / 대한비뇨기과학회지

Renal and perinephric abscess are uncommon diseases with a multitude of clinical presentations. In past morbidity and mortality were high rate because of delay in diagnosis. Diagnosis and treatment approaches were challenged recently by newer imaging modalities as ultrasonography and CT scanning and by interventional uroradiology. A clinical observation was made in 9 patients with renal abscess and 1O patients with perinephric abscess admitted in the Dept. of Urology, Kyung Hee University Hospital during the period from Jan. 1981 to Jan. 1986. The following results were observed: 1. Among 19 patients, 11 patients were women and their age was ranged from 22 to 68 yrs old with mean of 44.5 yrs. In 12 cases, Lt. kidneys were involved. 2. In 5 patients who had positive urine culture, E. coli was recovered in 3 cases, and klebsiella sp. and staph. epldermidis were recovered in one case, respectively. Blood culture was positive in one case. Among 14 cases performed pus culture, bacteria was recovered in 8 cases: E. coli in 4 cases staph. aureus in 2 cases, and staph. epldermidis and peptococcus in one case, respectively. 3. In 15 cases, diagnosis could be confirmed by ultrasonography, but CT scan was needed in 4 cases to confirm the nature of lesion. The common findings of ultrasonogram were mixed echogenic mass and echolucent mass found in 8 cases and 7 cases, respectively. 4. Among 19 cases, 1O patients underwent open drainage, 5 cases were treated by antibiotics only, and 3 cases were managed successfully by closed drainage.

A Clinical Survey on Perinephric Abscess / 대한비뇨기과학회지

A clinical survey was made on 15 cases of perinephric abscess who were admitted to the department of urology during 12 years from May, 1972 to April, 1984. We reviewed perinephric abscess, analyzed according to incidence, symptoms, laboratory finding, culture in urine and blood and abscess, sensitivity to antibiotics, associated disease, radiographic finding and treatment. On the abscess culture, the organisms were identified in 12 cases (80.0%) : S. aureus was in 5 cases, E. coli in 5 cases, Hemolytic streptococcus in 1 case and Klebsiella in 1 case. The diagnostic ultrasonographic evaluation in perinephric abscess performed in 6 cases and documented it was very highly valuable method. The treatment was satisfactory with incision and drainage in 9 cases and with nephrectomy in 6 cases. The average duration of hospital stay was 21 days.

A Clinical Observation on Perinephric Abscess (II) / 대한비뇨기과학회지

We reviewed retrospectively 15 cases of perinephric abscess from 1970 to 1982 and compared these results to previously published data from 1970 to 1977 (Report I) 1. The organisms causing abscesses were determined as follows: S. aureus was in 7 cases (46%), E. coil in 4 cases (27%), Klebsiella in 2 cases (13%), Acinetobacter in 2 cases (13%), In addition, three patients had multiple abscess pathogens. 2. Laboratory evaluation revealed as follows: Pyuria was present in 4 cases (27%), Blood culture were positive in 2 cases (13%) and urine culture was positive in one case. The organisms isolated from blood and urine were felt to be the organism causing the abscesses. 3. There is no remarkable change in species of sensitive drugs, when comparing with that of previous Report I . 4. Four cases had underlying renal diseases (3 in chronic pyelonephritis and 1 in renal injury) and two cases had associated conditions (1 in impetigo and 1 in diabetes)

A Clinical Observation on Perinephric Abscess / 대한비뇨기과학회지

Perinephric abscess is a collection of pus in the space between the kidney and Gerota's fascia. The abscess usually is confined to Gerota's fascia but may extend in several directions, such as a draining flank abscess through Petit's triangle or subphrenic abscess. Rarely, this abscess perforates interpersonally or into the colon. Recently the majority of perinephric abscesses revealed that Gram negative organisms are more prevalent and are attributable to renal disease. This is a report on 6 cases of perinephric abscess admitted to National Medical Center during the pried from January 1970 to August 1977. The results are summarized briefly as follows : 1. Among the 6 cases of perinephric abscess, male was 5 cases and female 1 case Average age was 30 years. 2. 5 cases were located at Rt. side and 1 case at Lt side. 3. Main symptoms were flank pain, palpable mass and fever except 1 case, which was general weakness and weight loss. 4. Duration of symptom prior to adm. was variable, from 10 days to 1 year, average 88 days . 5. Pyuria was noted in 3 cases and leukocytosis in 5 cases. Of the abscess culture, 3 cases were E. coli, 2 cases Staphaureus and 1 case negative. 6. Psoas and renal shadow were obliterated in majority and I. V. P. revealed nonvisualization in 2 cases, faint and delayed visualization in 3 cases, kidney displacement in 3 cases and kidney fixation in 3 cases. 7. Only I & D was done in 3 cases and I & D with nephrectomy in 3 cases. 8. Kidney biopsy revealed chronic pyelonephritis in 2 cases and non-specific pyonephrosis in 1 case. 9. Average duration of Hosp, stay was 20 days.