An unusual case of an extensive post-injection retroperitoneal abscess in an intravenous drug user.

Retroperitoneal abscesses constitute an uncommon, complex, and life-threatening intra-abdominal infection. The insidious nature of the presentation, coupled with the presence of non-specific clinical symptoms, might result in misdiagnosis or delayed diagnosis, ultimately contributing to substantial morbidity and mortality. Herein we report a case of a 32-year-old intravenous drug user who presented to the emergency department complaining of high-grade fever, intense hiccough, and back pain due to retroperitoneal abscess formation after intravenous injection in the left femoral vein.

Retroperitoneal abscess associated with closed pelvic ring fracture diagnosed by fine free air on initial trauma pan computed tomography scan.

The patient was a 49-year-old male. He had a closed fracture of the pelvic ring that was treated successfully by avoiding anterior pelvic ring stabilization because of the presence of microscopic free air in the retroperitoneal space behind the pubic bone on initial whole-body trauma computed tomography scan. For his pelvic ring injury, transiliac rod and screw fixation was performed without the need for a pubic symphysis plate by developing the retroperitoneal space. His retroperitoneal abscess was treated by minimally invasive treatment of retroperitoneal abscess with computed tomography-guided percutaneous drainage. At 2 years postoperatively, there was no fever or elevated inflammatory response suspicious of retroperitoneal abscess recurrence. In this case, the presence of microscopic free air influenced the choice of treatment. Even in closed pelvic ring fractures, the presence of free air should be carefully considered when reading images.

Retroperitoneal abscess as a presentation of colon cancer: The largest case set analysis to date, which extracted from our unit and the literature.

Objective: Colon cancer with retroperitoneal abscess is a rare and easily misdiagnosed disease and has only been reported via case. There is an urgent need to conduct a dataset analysis for such patients, which is crucial to improving the survival rate and quality of life of these patients. Methods: Patients with colon cancer associated with retroperitoneal abscess were extracted from our hospital and the PubMed, EMBASE and Web of Science databases. Clinical information, including the patients' basic characteristics, clinical symptoms, laboratory tests, imaging examinations, treatment methods and prognosis was analyzed. Results: Sixty-one patients were analyzed, with an average age of 65 years. The proportions of right and left colon cancers were 63.9% and 36.1%, respectively. A total of 98.0% of the patients had adenocarcinoma. Many patients have insidious symptoms such as fever and weight loss. At the first medical visit, pain was the most common symptom (71%), with pain in the thigh (21.8%), abdomen (21.8%), and waist and back (14.5%) ranking among the top three. The misdiagnosis rate of the patients referred to our department was 75%, while the overall misdiagnosis rate in the literature was 43.9%. Laboratory tests show that these patients often have elevated white blood cells and anemia. CT examination showed that 87.2% of patients had an iliopsoas muscle abscess, and tumors were not simultaneously detected in 37.2%. A total of 33.9% of patients had local abscesses of the iliopsoas muscle, 26.4% had drainage into the subcutaneous tissue of the waist and upper buttocks, and 22.6% had drainage around the adductor muscle group of the thigh. These patients have a variety of treatments, and many patients have undergone multiple and unnecessary treatments. Thirteen patients died after surgery, and 6 died in the hospital, of whom four were patients undergoing direct surgery, and the other 7 died after discharge due to cachexia. Conclusion: Colorectal cancer with retroperitoneal abscess is a relatively rare and easily misdiagnosed subtype of colon cancer. It is more likely to occur in right-sided colon adenocarcinoma. The main clinical symptom is pain caused by the drainage of pus to the corresponding areas of the waist, abdomen, and legs. CT is the preferred diagnostic method. Actively treating the abscess and then transitioning to standard colon cancer treatment can prevent patient death and improve treatment quality.

Multiple Retroperitoneal Abscesses Caused by Citrobacter koseri are Associated with a Poor Prognosis: A Case Report.

Citrobacter koseri causes opportunistic infections in various organs. We herein report an 84-year-old man with diabetes mellitus who presented to our hospital with left hip pain and walking difficulty. Computed tomography showed an extensive abscess with gas production, mainly in the left retroperitoneal space, caused by C. koseri infection. Despite daily cleaning of the wound and antimicrobial therapy (with surgical drainage), the patient developed repeated pneumonia and small bowel hemorrhaging caused by disseminated intravascular coagulation and died on day 65 of hospitalization. Overall, retroperitoneal abscesses caused by C. koseri are rare, and multiple abscesses may show a poor prognosis.

Development of Retroperitoneal Abscess Following Routine Injection of Triamcinolone for Musculoskeletal Pain.

Glucocorticoid intramuscular injections are a quick, routine procedure done in an outpatient setting to relieve musculoskeletal pain quickly. However, despite being a low-risk procedure it can lead to local infections, including abscess and skin necrosis, and even more rarely, bacteraemia and multi-organ failure. In this case, we present a healthy, immunocompetent woman in her 40s diagnosed with a retroperitoneal abscess due to methicillin-resistant Staphylococcus aureus after an intramuscular injection of triamcinolone. LEARNING POINTS: Injections of glucocorticoids are commonly used in medical practice to alleviate musculoskeletal pain in addition to oral non-steroidal anti-inflammatory agents.Complications of injections include abscess formation, skin necrosis and sepsis, typically from Staphylococcus aureus or other skin colonisers.It should be understood that there are risks associated with injections regardless of age or co-morbidities, so these risks should be discussed with the patient in depth before administration.

Unusual presentation of extended iliofemoral deep vein thrombosis caused by giant retroperitoneal abscess: a rare case report.

Secondary deep vein thrombosis due to a mass effect on the venous system has been reported in the literature. Venous thrombosis is frequently seen in the lower extremities; however, when seen at the iliac level, the mass effect of an underlying pathology must be considered. Identifying such etiologies guides the management and reduces the risk of recurrences. Case Presentation: In this report, the authors present a case of an extended iliofemoral vein thrombosis caused by a giant retroperitoneal abscess (RA) in a 50-year-old woman with underlying type 2 diabetes mellitus, presenting with painful left leg swelling and fever. Color venous Doppler ultrasonography and computed tomography scan of the abdomen and pelvis findings were compatible with a left voluminous RA compressing the left iliofemoral vein with an extended deep vein thrombosis. Conclusions: The mass effect on the venous system is rare in RAs, but it must be kept in mind. In light of this case and literature review, the authors highlight the diagnosis and management difficulties in handling this unusual presentation form of a RA.

Empyema with an extensive retroperitoneal abscess after the first dose of the COVID-19 vaccine, a case report.

Introduction: The most common side effects were mild pain at the injection site and fever after the COVID-19 vaccination. A retroperitoneal abscess is a rare disorder with a deceptive onset and difficult diagnosis. It has various reasons and is related to a high mortality rate. Case presentation: A 29-year-old man with a recent history of first-dose Covid-19 vaccination, was referred for dyspnea, chest, and abdominal pain. Chest imaging revealed a lung abscess evacuated to pleural space. Left posterolateral thoracotomy surgery was done. Post-operation abdominopelvic imaging revealed increased fat stranding and fluid collection, suggesting retroperitoneal infection and abscess formation and the patient underwent drainage. Clinical discussion: Common side effects after COVID-19 vaccination were mild and expectable without hospitalization. But in our case, a rare complicated side effect was seen. Conclusion: Uncommon side effects should be observed to recognize whether they are related to the vaccine or not.

Surgical Management of a Retained Appendicolith Following Laparoscopic Appendectomy.

Appendicitis is one of the most common surgical emergencies, and surgical intervention remains the gold standard for curative treatment. Although laparoscopic appendectomy is associated with less pain, shorter hospital stays, and earlier mobilization, it is also more frequently complicated by postoperative abscesses. Retained appendicoliths are a rare complication that can serve as a nidus for repeated infections. Laparoscopic removal of the stone can provide definitive source control and reduce repeated hospital admissions. There are many surgical approaches for retrieval and this case, in particular, describes a laparoscopic hand-assisted approach while simultaneously using an interventional radiologic drain to assist with localization.

Dropped Gallstone Mimicking Retroperitoneal Tumor 5 Years After Laparoscopic Cholecystectomy Posing a Diagnostic Challenge.

Laparoscopic cholecystectomy is the standard treatment for cholecystitis. The major complications associated with laparoscopic cholecystectomy include bleeding, abscess formation, biliary injury with bile leakage, and bowel injury. Gallbladder perforation and subsequent stone spillage are not uncommon in laparoscopic cholecystectomy. The majority of these spilled stones remain clinically silent. But sometimes they can cause abscesses and make diagnosis challenging especially when it occurs years after the procedure and when the abscess form in uncommon sites. A 66-year-old female with a history of laparoscopic cholecystectomy presented with aggravating abdominal pain in the right upper quadrant (RUQ). The CT abdomen revealed a mass in the retroperitoneum behind the hepatic flexure. Upon further examination, follow-up CT scans, and biopsy repeatedly failed to exclude malignancy, so it was suggested that the patient undergo surgical removal of the mass. The pathological analysis of the excised mass revealed that it was a dropped gallstone from the procedure that triggered an inflammatory reaction. Dropped gallstones should be considered as a differential diagnosis in a patient with a history of laparoscopic cholecystectomy presenting with an abdominal or retroperitoneal abscess, as a failure of early recognition puts the patient at risk of undergoing unnecessary and invasive procedures.

Vertebral Osteomyelitis Secondary to a Retroperitoneal Abscess in an Adolescent Male: A Case Report.

Pyogenic vertebral osteomyelitis (PVO) is included in a spectrum of spine infections called spondylodiscitis. It is commonly caused by hematogenous seeding. The annual incidence of spondylodiscitis is 2.4 per 100,000 person-years and the incidence triples for people over seventy. We report a case of a previously healthy 14-year-old male with a rare presentation of vertebral osteomyelitis associated with a large retroperitoneal abscess of unknown origin, manifested with flank pain, back pain, and fever, and treated with antibiotics with good short-term outcomes. We concluded that vertebral osteomyelitis in adolescent patients could manifest with back or flank pain. Moreover, it can occur as an extraperitoneal manifestation of a retroperitoneal abscess.

Perforated retrocecal appendicitis presenting with lung abscess-A case report.

Retrocecal appendicitis usually presents with atypical signs and symptoms which may lead to delayed diagnosis, perforation and serious complications. Development of a large lung abscess secondary to perforation of retrocecal appendicitis in an adolescent patient is an extremely rare entity and to the best of our knowledge has not been described in literature. We present a 15-year-old boy with complaint of chest pain, cough, fever, vague abdominal pain and raised inflammatory markers who underwent CT examination. On CT, a collection with focal calcification was noted in the right iliac fossa that extended along the right retroperitoneum through the retrocrural space in the right lung base communicating with a cavitary pulmonary lesion with air-fluid level. A diagnosis of perforated retrocecal appendicitis with retroperitoneal and right lung abscesses was made. The patient underwent appendectomy and the entire retroperitoneal and lung abscesses were drained. A lung abscess as a complication of perforated retrocecal appendicitis should be in consideration in septic patients with thoracoabdominal infectious manifestations.

Appendicolith as a cause of late complications after appendectomy - a case report and literature review.

INTRODUCTION: Acute appendicitis is one of the most common acute abdominal conditions. One of its complications is postoperative formation of abscesses in the peritoneal cavity or in the retroperitoneal space. Among other things, appendicoliths left in the peritoneal cavity are responsible for this process. Their release from the lumen occurs preoperatively and during the operation. An appendicolith, with the bacteria present on its surface, provides an environment that supports the onset of an infection. CASE REPORT: The authors present a less common case of a retroperitoneal abscess caused by an incarcerated appendicolith. Unusual is the long period between appendectomy and clinical manifestations of the abscess. The patient underwent surgical treatment with abscess evacuation and extraction of the appendicolith. The postoperative course was adequate; wound healing was supported by negative wound pressure therapy. CONCLUSION: During appendectomy, it is necessary to keep in mind the risk of releasing appendicoliths and their role in infectious complications. A conscientious revision of the peritoneal cavity is required, as well as a good surgical technique. If necessary, imaging methods can help to locate the appendicolith in the postoperative period.

A rare case of retroperitoneal extension in Fournier's gangrene: A case report and review of literature.

Introduction and importance: Retroperitoneal extension is a rare and fatal complication of Fournier's gangrene (FG) which mandates immediate surgical intervention for better outcome. Case presentation: A 70-year-old male presented to the emergency department with a history of bilateral painful scrotal swelling for 7 days with fever and abdominal pain for 3 days. On his general examination, he was septic with necrotic patches in the perineum and bilateral scrotum. Imaging revealed soft tissue gas and collections in scrotum extending to the right retroperitoneum with massive collection suggestive of retroperitoneal abscess. Following resuscitation and intravenous antibiotics, immediate exploratory laparotomy was done to drain the retroperitoneal abscess followed by debridement of Fournier's gangrene. The patient remained well on follow up. Clinical discussion: Fournier gangrene is a fulminant polymicrobial infection of the perineum, scrotum and penis which when complicated by retroperitoneal extension, has a very high mortality. Majority of patients have an immunocompromised condition. Early diagnosis with prompt surgical drainage and debridement (within 6 hours) significantly reduces the mortality. Conclusion: High index of suspicion, careful clinical examination and timely use of imaging is crucial for early diagnosis of this rare but fatal complication of FG. Furthermore, adequate resuscitation with prompt surgical intervention is the key for a favorable outcome.

Percutaneous catheter drainage in retroperitoneal abscesses: a single centre's 8-year experience.

Purpose: We have investigated the technical and clinical success of percutaneous catheter drainage (PCD) in retroperitoneal abscesses and factors that may affect the outcome. Material and methods: The study cohort included 45 patients (17 females and 29 males, with mean age of 56.3 years) that were treated between 2012 and 2020. Forty-seven abscesses were managed with PCD under ultrasonography, computed tomography, or fluoroscopy guidance. Patients' demographics, lesion locations, predisposing factors, clini-cal presentation, etiology, radiological findings, technical factors, and outcome parameters were presented using exploratory and descriptive statistics. Results: Abscesses were located in the psoas (n = 25, 55.3%), renal-perirenal (n = 7, 14.8%), and pararenal (n = 14, 29.7%) compartments. The mean preprocedural volume was 263.3 (30-1310) ml. Pain (abdominal and back) (57.4%) and fever (17%) were the most frequent presenting symptoms. The most common predisposing factors were previous surgery (n = 17, 36.1%) and diabetes mellitus (n = 11, 25.5%). Clinical success was attained in 89.3% of abscesses (definitive treatment 72.3% and partial success 17.0%). There was a statistically significant difference between the iatrogenic and non-iatrogenic groups regarding clinical success (p = 0.031). No mortality was encountered. The complication rate was 6.6% and were all minor. The average rate of recurrence was 10.6%. The mean time to catheter removal was 15.8 ± 13.2 days. Conclusions: PCD is a safe and effective procedure in the treatment of retroperitoneal abscesses. Procedure-related mortality, morbidity, and complication rates are low. Underlying etiology is a significant factor affecting the outcome. Nevertheless, PCD may provide definitive treatment in the majority of patients.

A case of retroperitoneal abscess caused by infection of urachal remnant.

Infection of urachal remnant may cause recurrent abscesses. In the current case report, we describe a urachal remnant infection leading to a retroperitoneal abscess, which is an extremely rare condition. In such cases, the recommended treatment is urachal remnant resection.

Retroperitoneal abscess caused by dropped renal stones.

Staghorn calculi account for about 4% of presenting renal stones in developed countries, are source of recurrent urinary tract infection, and may be eventually treated by surgical stone removal. A 55-year-old female with a history of staghorn renal calculi and recurrent urinary tract infections presented with a left flank and lower abdominal pain following recent left robotic partial nephrectomy and nephrolithotomy. Contrast-enhanced computed tomography (CT) of the abdomen demonstrated a large left-sided retroperitoneal fluid collection with a few dropped renal stones in the dependent portion of the collection. The patient treated with early percutaneous drainage of the collection and antibiotic treatment and responded well clinically. The clinical and imaging presentation of a rare case of retroperitoneal abscess formation caused by dropped renal stones is described in this study. Imaging, particularly ultrasound and CT, plays a key role in detecting the dropped renal stones and can help with differential diagnosis and treatment plans.