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.

Should We Change the Initial Treatment of Renal or Retroperitoneal Abscess in High Risk Patients?

INTRODUCTION: This study examined the risk factors for initial treatment failure in renal or retroperitoneal abscess as a multicenter study. MATERIALS AND METHODS: This retrospective analysis investigated consecutive patients with renal or retroperitoneal abscess who were hospitalized in Japan. The outcomes of these patients were classified into "cured" and "failure or recurrence." The potential clinical risk factors examined were abscess size, diabetes mellitus, major organ failure, laboratory data, fever, drainage, and causative organisms, for instance. RESULTS: Of the 74 patients, 40 (54.1%) were diagnosed with renal abscess and 34 (45.9%) with retroperitoneal abscess, 51 (68.9%) were cured by initial treatments, and 23 (31.1%) underwent failure or relapse; 33 (44.6%) were men and 41 (55.4%) were women. In detail, 36 patients were cured by conservative therapy only. Our multivariate analysis data showed that renal failure was the only significant factor for initial treatment failure (p = 0.0281). CONCLUSIONS: Our multivariate analysis showed that renal failure was a significant risk factor for initial treatment failure or recurrence.

Feasibility and outcomes of laparoscopic renal intervention after prior open ipsilateral retroperitoneal surgery.

BACKGROUND AND PURPOSE: Treating patients with renal-cell carcinoma (RCC) after previous retroperitoneal surgery (renal or adrenal) is technically challenging. We present our initial experience with laparoscopic renal interventions (LRI) after previous open retroperitoneal surgery in patients needing ipsilateral renal intervention. We report on feasibility, functional and oncologic outcomes of LRI after previous open retroperitoneal surgery. PATIENTS AND METHODS: We reviewed records of patients undergoing attempted laparoscopic or robot-assisted renal intervention after at least one previous open ipsilateral retroperitoneal surgery. We identified 34 patients who underwent 39 staged attempted LRI after 48 previous open ipsilateral renal or adrenal surgeries. The LRI included 20 minimally invasive partial nephrectomies (MIPN), 11 laparoscopic radiofrequency ablations (LRFA), and 8 laparoscopic nephrectomies (LTN). Demographic, perioperative, renal functional, and oncologic outcome data were collected. Statistical analyses were performed to identify risks for conversion to open surgery. RESULTS: No attempted nephron-sparing procedure resulted in kidney loss. Overall conversion rate of the cohort was 28% and was highest in the MIPN group (40%). On univariate analysis, only multiple tumors that were treated significantly increased chances of open conversion (P<0.01). Subset analysis demonstrated similar rates of blood loss, operative times, and conversion rates in patients undergoing partial nephrectomy having previous open partial nephrectomy compared with previous open adrenal surgery only. There was no significant difference in preservation of renal function between MIPN and LRFA, with more than 85% of preoperative renal function preserved. Mean follow-up of 11.9 months (range 1-97.5 mos) metastasis-free survival and overall survival was 94.1% and 97%, respectively. CONCLUSIONS: LRI after previous open ipsilateral retroperitoneal surgery is feasible. Repeated partial nephrectomy has the highest conversion risks among the laparoscopic renal interventions and appears to be independent of previous renal or adrenal procedure. Attempting repeated LRI for multiple tumors is a significant risk factor for open conversion. Renal functional and oncologic outcomes are encouraging at early follow-up.

Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review.

Cisterna chyli is prone to injury in any retroperitoneal surgery. However, retroperitoneal chylous leakage is a rare complication after anterior spinal surgery. To the best of our knowledge, only ten cases have been reported in the English literature. We present a case of a 49-year-old man who had lumbar metastasis and associated radiculopathy. He had transient retroperitoneal chylous leakage after anterior tumor decompression, interbody bony fusion, and instrumental fixation from L2 to L4. The leakage stopped spontaneously after we temporarily clamped the drain tube. Intraperitoneal ascites accumulation developed thereafter due to nutritional loss and impaired hepatic reserves. We gathered ten reported cases of chylous leak after anterior thoracolumbar or lumbar spinal surgery, and categorized all these cases into two groups, depending on the integrity of diaphragm. Six patients received anterior spinal surgery without diaphragm splitting. Postoperative chylous leak stopped after conservative treatment. Another five cases received diaphragm splitting in the interim of anterior spinal surgery. Chylous leakage stopped spontaneously in four patients. The remaining one had a chylothorax secondary to postop chyloretroperitoneum. It was resolved only after surgical intervention. In view of these cases, all the chylous leakage could be spontaneously closed without complications, except for one who had a secondary chylothorax and required thoracic duct ligation and chemopleurodesis. We conclude that intraoperative diaphragm splitting or incision does not increase the risk of secondary chylothorax if it was closed tightly at the end of the surgery and the chest tube drainage properly done.

Are some cases of infected pancreatic necrosis treatable without intervention?

BACKGROUND: Infected pancreatic necrosis is considered an absolute indication for interventional management such as percutaneous drainage or surgery. The presence of retroperitoneal air is a sign of anaerobic sepsis. METHOD: A retrospective review of case records of patients presenting with severe acute pancreatitis and pancreatic necrosis was performed to identify cases in whom conservative treatment was followed by a satisfactory outcome. RESULTS: Four patients were identified over a 3-year period who had pancreatic necrosis and retroperitoneal air; they were treated with antibiotics and intensive care, and they improved without any interventional treatment. CONCLUSIONS: Some patients with infected pancreatic necrosis are treatable medically. The clinical status of the patients may well be a more important factor governing the choice of the treatment approach than bacteriological findings of infection alone.

Leiomiossarcoma retroperitoneal / Retroperitoneal leiomyosarcoma

O leiomiossarcoma retroperitoneal é patologia rara na prática cirúrgica. O diagnóstico precoce é ocasional, pois não existem sintomas específicos. O tratamento cirúrgico é a modalidade que pode oferecer chance de cura. A radioterapia pode ser útil. Os autores relatam um caso de leiomiossarcoma retroperitoneal manifestado por abdome agudo, uma apresentação atípica

Traumatismo Retroperitoneal / Retroperitoneal Traumatism

Los traumatismos retroperitoneales son para el cirujano una entidad de gran importancia aunque su diagnóstico y tratamiento oportuno no se realicen con facilidad. No hay signos o síntomas que permitan asegurar la existencia de lesión en órganos retroperitoneales, pero el uso de técnicas diagnósticas en ciertos casos conducen a la pronta consecución de un diagnóstico adecuado, mejorando así el pronóstico de estos pacientes. Los hematomas retroperitoneales se clasifican en centrales, de los flancos, pélvicos y combinados; cada uno de ellos, de acuerdo a sus características, presenta un tratamiento y pronóstico diferente. En cuanto a las heridas penetrantes posteriores, un correcto examen clínico es la clave del enfoque terapéutico

[Abscess of the abdominal wall: a rare presentation of xanthogranulomatous pyelonephritis]. / Abcès de la paroi abdominale: une présentation rare d'une pyélonéphrite xanthogranulomateuse.

A young psychiatric patient presented with a purulent collection in the lower abdominal wall. Simple drainage failed to heal the abdominal wall abscess, and the presence of a primary septic focus was suspected. Full investigation showed a right renal pelvis calculus with xanthogranulomatous pyelonephritis complicated by a retroperitoneal abscess. Recovery was complete after a nephrectomy. A review of the published literature demonstrated the rarity of this presentation, although even more curious cases have been described, including a urinobronchial fistula, as well as catastrophic cases presenting with a massive haemorrhage. Authors are unanimous that ultrasonography should be the first examination, the scanner being also of primordial value for the diagnosis and demonstration of the retroperitoneal spaces ans fascia. Treatment requires both rapid and radical surgical intervention.

A large retroperitoneal encapsulation of bile from a spontaneous perforation of the common bile duct.

We report a patient with spontaneous rupture of the common bile duct. This is an extremely rare condition which produces free leakage of bile into the peritoneal cavity. There has been no previous report concerning the formation of a large retroperitoneal encapsulation of bile. The preoperative diagnosis in our patient was very difficult and endoscopic retrograde pancreatocholangiography and cystography by ultrasound guidance were helpful.