Retroperitoneal abscess: an extra-abdominal manifestation

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.

Complicated retroperitoneal diverticulitis presenting with abscess and acute limb ischemia

This case highlights a rare presentation of diverticulitis of the sigmoid colon with perforation into the retroperitoneum complicated by abscess, vertebral osteomyelitis and acute lower extremity ischemia. A late 40-year-old man presented to an emergency department with acute ischemia of his left lower extremity. He was tachycardic with a leucocytosis, an unremarkable abdominal exam and a pulseless, insensate and paralysed left lower extremity. Imaging revealed sigmoid thickening, an abscess adjacent to iliac vasculature and occlusion of the left popliteal artery. The abscess came in contact with prior spine anterior lumbar interbody fusion (ALIF) hardware at L5-S1 vertebrae. The patient was taken urgently to the operating room for embolectomy, thrombectomy and fasciotomy. He was started on antibiotics and later underwent operative drainage with debridement for osteomyelitis. Non-operative management of the complicated diverticulitis failed, necessitating open sigmoidectomy with colostomy. 1 year later, he was symptom-free and the colostomy was reversed.

Spontaneous Retroperitoneal Methicillin-Resistant Staphylococcus aureus Abscess in a Pediatric Patient

Retroperitoneal abscesses are relatively uncommon in infants and children. They carry a high rate of morbidity due to insidious onset and pose a diagnostic challenge. Here we report a case of spontaneous retroperitoneal methicillin-resistant Staphylococcus aureus (MRSA) infection in a two-year-old patient. The patient was successfully treated with antibiotics and surgical washout and drainage. A retroperitoneal abscess is usually found in patients with a history of osteomyelitis, seeding of post-traumatic pelvic hematomas, post radiation, or perforated hollow viscus including but not limited to: perforated appendicitis, bowel perforations due to foreign objects or malignancy, or perforated diverticulitis. Most of these conditions are usually found in the adult population. As per a recent literature search, there are no reported cases of a spontaneous retroperitoneal MRSA abscess in the pediatric population without risk factors.

Extra-abdominal manifestations of retroperitoneal infection: a case of popliteal sinus secondary to duodenal ulcer

Retroperitoneal abscesses can be gastrointestinal, urological or vascular in origin, and can spread via the retrofascial compartment through the psoas muscle to the lower limb. We describe the case of a 73-year-old woman with right knee pain for three weeks, a cellulitic right thigh and cholestatic liver function tests. A purulent sinus developed in the popliteal fossa and computed tomography of the abdomen revealed a right-sided retroperitoneal collection with gas, extending to the right pelvis and inguinal region. The popliteal fossa sinus and retroperitoneal collection were identified as a single pathology through computed tomography, magnetic resonance imaging and culture of identical organisms. At laparotomy, perforated duodenal ulcer disease was identified as the cause of the retroperitoneal abscess. Clinicians should seek to exclude retroperitoneal sources of infection in cases of lower leg infection, including perforated duodenal ulcer, caecal adenocarcinoma and appendicitis.

Successful Medical Management of a Retroperitoneal Abscess: A Difficult Diagnosis in Pyrexia of Unknown Origin

Retroperitoneal abscesses are uncommon conditions with occult and insidious presentations. There is often a lack of abdominal signs and ultrasound findings, causing a delay in diagnosis and definitive treatment, leading to poor patient outcomes. We report a case of right-sided retroperitoneal abscess of a 28-year-old female patient with diabetes mellitus. Prior to admission, the patient reported a vague 2 weeks history of right-sided back and abdominal pain and dysuria. She presented to our medical ward with suspected pyelonephritis with right-sided renal abscess. A retroperitoneal abscess involving the right renal fossa was revealed on an urgent CT scan. The patient underwent percutaneous ultrasound-guided pigtail catheter drainage. Patient clinically and biochemically improved with medical management gradually over 2 weeks. This case report highlights the importance of investigating for recurrent urinary tract infections of diabetics which are often overlooked in general practice.