RESUMEN
We treated an 85-year-old man with an abscess perforating into the retroperitoneal space from the sigmoid colon, with retroperitoneal drainage combined with antibiotics. CT showed no abscess formation in the intraperitoneal space. The patient consulted a doctor with a chief complaint of left-side low back pain and fever. He was first diagnosed with bacteremia due to Escherichia coli and close examination by CT revealed a retroperitoneal abscess. On referral to our hospital, we determined by CT that the cause of abscess formation was perforation of the intestine into the retroperitoneal space and spreading into the psoas muscle compartment. We then performed colostomy and abscess drainage through the retroperitoneal space to prevent the abscess disseminating into the intraperitoneal space. The abscess and necrotic tissue cultures were polymicrobial, including Enterobacteriaceae and Bacteroides spp. The abscess almost disappeared after drainage, and the patient's general condition gradually improved. The retroperitoneal abscess did not relapse by follow-up CT. In conclusion, this rare case presented with perforation of the intestine (Sigmoid colon) disseminated only to the retroperitoneal space without no intraperitoneal space abscess formation. We performed drainage only by a retroperitoneal approach without entering the intraperitoneal space.
Asunto(s)
Absceso Abdominal/microbiología , Absceso/microbiología , Antibacterianos/uso terapéutico , Coinfección/diagnóstico , Coinfección/terapia , Colon Sigmoide/lesiones , Drenaje/métodos , Perforación Intestinal/complicaciones , Espacio Retroperitoneal/microbiología , Absceso Abdominal/diagnóstico , Absceso Abdominal/etiología , Absceso Abdominal/cirugía , Absceso/complicaciones , Anciano de 80 o más Años , Bacteroides , Coinfección/microbiología , Colon Sigmoide/patología , Colostomía , Enterobacteriaceae , Escherichia coli , Fiebre/etiología , Humanos , Perforación Intestinal/diagnóstico , Perforación Intestinal/cirugía , Masculino , Espacio Retroperitoneal/diagnóstico por imagen , Espacio Retroperitoneal/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Necrotising fasciitis (NF) is a potentially lethal spread of infection that is uncommonly seen within the province of surgery. Seen mostly in the extremities and the perineal regions, it has been reported rarely to involve the retroperitoneal space and presents with a spectrum of symptoms and signs as such. Literature supports classification of NF based on the microbes involved. Irrespective of the aetiology and the causative organism, NF remains a serious surgical emergency with high morbidity and mortality not only associated with the disease process itself, but also with the extensive surgical debridement it requires in its management along with antimicrobial administration. We present a case of such an infection found in the retroperitoneal space secondary to a perineal infection forming a rare presentation of this deadly process, and how it was successfully managed secondary to timely surgical intervention.
Asunto(s)
Fascitis Necrotizante/diagnóstico por imagen , Perineo/microbiología , Espacio Retroperitoneal/microbiología , Administración Intravenosa , Anciano , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Colostomía/métodos , Corynebacterium/aislamiento & purificación , Desbridamiento , Fascitis Necrotizante/tratamiento farmacológico , Fascitis Necrotizante/cirugía , Femenino , Humanos , Yeyunostomía/métodos , Laparotomía/métodos , Perineo/diagnóstico por imagen , Perineo/patología , Perineo/cirugía , Espacio Retroperitoneal/patología , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoAsunto(s)
Abdomen Agudo/patología , Lesión Renal Aguda/diagnóstico , Traumatismos de la Médula Espinal/complicaciones , Abdomen Agudo/diagnóstico por imagen , Absceso Abdominal/tratamiento farmacológico , Absceso Abdominal/cirugía , Antibacterianos/uso terapéutico , Citrobacter koseri/aislamiento & purificación , Drenaje/métodos , Humanos , Masculino , Persona de Mediana Edad , Espacio Retroperitoneal/microbiología , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiologíaRESUMEN
BACKGROUND: Several infectious processes of intra-abdominal origin may atypically present as skin or soft tissue infections or abscess in the thigh. CASE REPORT: We describe the case of a 73-year-old woman who presented to the emergency department with the clinical picture of a skin infection of the right leg. The patient's condition deteriorated during medical treatment with intravenous antibiotics. Subsequent radiologic imaging revealed that the complaints were caused by a bulging retroperitoneal appendicular abscess along the iliopsoas muscle, although the patient experienced no abdominal symptoms. The patient recovered completely after surgical intervention. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Timely performance of anatomic imaging in patients with unexplained skin or soft tissue infections and thigh abscesses is important because these findings may be manifestations of an abdominal pathology. A correct diagnosis in the emergency department prohibits delays in treatment.
Asunto(s)
Apendicitis/diagnóstico , Celulitis (Flemón)/diagnóstico , Infecciones de los Tejidos Blandos/terapia , Anciano , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Apendicitis/complicaciones , Cefuroxima/farmacología , Cefuroxima/uso terapéutico , Celulitis (Flemón)/tratamiento farmacológico , Servicio de Urgencia en Hospital/organización & administración , Escherichia coli/patogenicidad , Femenino , Humanos , Klebsiella pneumoniae/patogenicidad , Imagen por Resonancia Magnética/métodos , Metronidazol/farmacología , Metronidazol/uso terapéutico , Piomiositis/diagnóstico , Espacio Retroperitoneal/anomalías , Espacio Retroperitoneal/microbiología , Infecciones de los Tejidos Blandos/complicaciones , Muslo/anomalíasRESUMEN
Laparoscopic cholecystectomy is the golden standard, considering treatment of cholelithiasis. During the laparoscopic procedure one may often observe damage to the gall-bladder wall, as well as presence of gall-stones in the peritoneal cavity, as compared to classical surgery. These gall-stones may be associated with the occurrence of various complications following surgery. The study presented a rare case of a retroperitoneal abscess, as a consequence of retained gall-stones, in a female patient who was subject to laparoscopic cholecystectomy two years earlier.
Asunto(s)
Colecistectomía Laparoscópica/efectos adversos , Cálculos Biliares/cirugía , Espacio Retroperitoneal/diagnóstico por imagen , Espacio Retroperitoneal/microbiología , Absceso Subfrénico/diagnóstico por imagen , Absceso Subfrénico/microbiología , Femenino , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Tomografía de Emisión de Positrones , Staphylococcus aureus/aislamiento & purificación , Absceso Subfrénico/tratamiento farmacológicoRESUMEN
Retroperitoneal abscesses present a relatively uncommon complication of diseases of various abdominal organs, although most commonly they are related to acute appendicitis of retrocoecal location. The paper presents the case of a healthy patient in whom an excessive left retroperitoneal abscess developed, perforated into the peritoneal cavity, and almost perforated through the skin in XIIth intercostal space. The patient had no abdominal symptoms or signs, but complained from slight pain in the left lumbar area. The diagnosis was established based on abdominal computed tomography scanning and an operative treatment by laparotomy. The evacuation and drainage of the abscess was effective and the patient recovered. Bacteriological examination of the pus from the abdominal cavity revealed single colonies of anaerobic Fusobacterium species. The cause of the occurrence of the abscess remained unknown.
Asunto(s)
Absceso Abdominal/diagnóstico por imagen , Absceso Abdominal/microbiología , Absceso Abdominal/cirugía , Fusobacterium , Humanos , Laparotomía , Masculino , Persona de Mediana Edad , Espacio Retroperitoneal/diagnóstico por imagen , Espacio Retroperitoneal/microbiología , Espacio Retroperitoneal/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Aggregatibacter aphrophilus is an uncommon cause of vertebral infections and its complications are infrequently seen. We believe ours is the first reported case of scrotal abscess as a complication of vertebral osteomyelitis. We have also reviewed nine cases with complications similar to this report. Epidural abscess is the most commonly found complication, having been reported in six patients, followed closely by psoas abscess, which was seen in five patients. All except one patient underwent surgical drainage, with all patients showing complete resolution of infection.
Asunto(s)
Infecciones por Pasteurellaceae/diagnóstico , Absceso del Psoas/microbiología , Espacio Retroperitoneal/microbiología , Hidrocele Testicular/microbiología , Adulto , Aggregatibacter aphrophilus/aislamiento & purificación , Epididimitis/microbiología , Humanos , Masculino , Osteomielitis/complicaciones , Osteomielitis/microbiologíaRESUMEN
Combined method of laparoscopically and retroperitoneoscopically assisted necrsequestrectomy, consisting of staged application of miniinvasive methods with simultaneous laparoscopic and retroperitoneoscopic control of necrsequestrectomy, was elaborated with the objective to improve surgical treatment of an acute pancreatitits. The procedure has significant advantages over open operative intervention in purulent complications of necrotic purulent pancreatitis: reduction of the local and systemic operative treatment severity, minimization of microbial metabolites coming into the blood, total visual control of intervention, reduction of the vascular injuries risk, аdequate surgical sanation with saving of viable pancreatic parenchyma, absence of conditions for the purulent complications occurrence while the operative wound healing is going on, preservation of possibility for an adequate draining, using drains of a large diameter.
Asunto(s)
Laparoscopía/métodos , Páncreas/cirugía , Pancreatectomía/métodos , Pancreatitis Aguda Necrotizante/cirugía , Espacio Retroperitoneal/cirugía , Supuración/cirugía , Anciano , Antibacterianos/uso terapéutico , Pérdida de Sangre Quirúrgica/prevención & control , Drenaje/instrumentación , Drenaje/métodos , Femenino , Humanos , Laparoscopía/instrumentación , Páncreas/microbiología , Páncreas/patología , Pancreatectomía/instrumentación , Pancreatitis Aguda Necrotizante/tratamiento farmacológico , Pancreatitis Aguda Necrotizante/microbiología , Pancreatitis Aguda Necrotizante/patología , Espacio Retroperitoneal/microbiología , Espacio Retroperitoneal/patología , Supuración/tratamiento farmacológico , Supuración/microbiología , Supuración/patología , Resultado del TratamientoRESUMEN
It was analyzed the treatment results of 108 patients with pancreonecrosis (PN). Gas-liquid chromatography with definition of blood concentration of volatile fatty acids (VFA) was used additionally for timely diagnostics of infected pancreonecrosis. Volatile fatty acids are toxic metabolites of microorganisms. Statistically significant threshold values of VFA were revealed. These values allow to diagnose timely early phase of PN infection and the nature of the microflora. It was defined changes of VFA depending on the severity of infectious process in pancreas and retroperitoneal fiber.
Asunto(s)
Bacterias/metabolismo , Cromatografía de Gases/métodos , Ácidos Grasos Volátiles , Pancreatitis Aguda Necrotizante , Espacio Retroperitoneal/microbiología , Adulto , Bacterias/clasificación , Manejo de la Enfermedad , Diagnóstico Precoz , Ácidos Grasos Volátiles/análisis , Ácidos Grasos Volátiles/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pancreatitis Aguda Necrotizante/diagnóstico , Pancreatitis Aguda Necrotizante/microbiología , Pancreatitis Aguda Necrotizante/fisiopatología , Pancreatitis Aguda Necrotizante/terapia , Reproducibilidad de los Resultados , Estudios Retrospectivos , Federación de Rusia , Índice de Severidad de la EnfermedadRESUMEN
Hydatid disease is a zoonotic infection resulting from the tissue infestation of the larval stage of the parasite Echinococcus granulosus. Hydatid cysts superinfected with pyogenic organisms have been reported previously. Brucellosis is more prevalent in people with close contact to animals and those consuming fresh milk or fresh milk products. Although these two disorders have some similar epidemiological features, we did not encounter any hydatid cyst cases superinfected with Brucella species (sp.) in a search of medical literature (Pubmed). Here, we present a case of hydatid cyst disease superinfected with Brucella and review the literature on other hydatid cyst cases superinfected with pyogenic organisms. We conclude that in regions where brucellosis and hydatid cysts are endemic, cysts may be infected with Brucella sp.
Asunto(s)
Brucella/aislamiento & purificación , Brucelosis/diagnóstico , Equinococosis/complicaciones , Equinococosis/diagnóstico , Echinococcus granulosus/aislamiento & purificación , Espacio Retroperitoneal/patología , Adulto , Animales , Brucelosis/patología , Equinococosis/patología , Humanos , Masculino , Espacio Retroperitoneal/microbiología , Espacio Retroperitoneal/parasitologíaAsunto(s)
Discitis/microbiología , Infecciones por Mycobacterium no Tuberculosas/complicaciones , Espacio Retroperitoneal/microbiología , Columna Vertebral/microbiología , Antibacterianos/uso terapéutico , Descompresión Quirúrgica , Humanos , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/terapia , Micobacterias no Tuberculosas , Fusión Vertebral , Estenosis Espinal/microbiología , Columna Vertebral/cirugíaAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Espacio Retroperitoneal/microbiología , Espacio Retroperitoneal/fisiopatología , Absceso/complicaciones , Absceso/diagnóstico , Enfermedades de la Vejiga Urinaria/complicaciones , Enfermedades de la Vejiga Urinaria/diagnóstico , Neoplasias de la Vejiga Urinaria/complicaciones , Neoplasias de la Vejiga Urinaria/diagnóstico , Espacio Retroperitoneal , Enfermedades de la Vejiga Urinaria/patología , Enfermedades de la Vejiga Urinaria , /métodos , Mycobacterium bovis/aislamiento & purificaciónAsunto(s)
Absceso/microbiología , Absceso/patología , Colorantes Azulados/metabolismo , Klebsiella oxytoca/fisiología , Azul de Metileno/metabolismo , Espacio Retroperitoneal/microbiología , Espacio Retroperitoneal/patología , Sarcoma/diagnóstico , Xantenos/metabolismo , Absceso/diagnóstico por imagen , Anciano de 80 o más Años , Biopsia con Aguja Fina , Enfermedad Crónica , Diagnóstico Diferencial , Humanos , Masculino , Espacio Retroperitoneal/diagnóstico por imagen , Tomografía Computarizada por Rayos XAsunto(s)
Absceso Abdominal/diagnóstico , Infecciones Neumocócicas/diagnóstico , Streptococcus pneumoniae , Absceso Abdominal/tratamiento farmacológico , Adulto , Antibacterianos/uso terapéutico , Cefotaxima/uso terapéutico , Humanos , Masculino , Pelvis/microbiología , Infecciones Neumocócicas/tratamiento farmacológico , Pristinamicina/uso terapéutico , Espacio Retroperitoneal/microbiología , Rifampin/uso terapéutico , Adulto JovenRESUMEN
Retroperitoneal abscesses are uncommonly encountered clinical entities and they represent serious surgical infections associated with significant mortality rates because of their insidious clinical manifestations and diagnostic difficulty. The source of retroperitoneal infections is usually an organ contained within or abutting the retroperitoneum, usually the kidney and the microorganisms most commonly isolated are gram-negative bacilli. Gram-positive cocci, mainly staphylococcal species and rarely streptococcal species, are a less common cause of retroperitoneal abscess and are usually isolated in cases of hematogenous spread. Treatment of retroperitoneal abscesses includes identification and treatment of underlying conditions, intravenous antibiotics and adequate surgical drainage of all well-defined collections. We present a rare case of retroperitoneal abscess caused by monomicrobial Streprococcus mutans infection and discuss the possible pathogenesis, clinical presentation, diagnosis and treatment.
Asunto(s)
Absceso Abdominal/diagnóstico por imagen , Espacio Retroperitoneal/diagnóstico por imagen , Infecciones Estreptocócicas/diagnóstico por imagen , Streptococcus mutans/aislamiento & purificación , Absceso Abdominal/microbiología , Absceso Abdominal/fisiopatología , Dolor Abdominal/etiología , Anciano , Diagnóstico Tardío , Fiebre/etiología , Humanos , Masculino , Espacio Retroperitoneal/microbiología , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/fisiopatología , Tomografía Computarizada por Rayos XRESUMEN
Cryptococcoma is a rare entity, characterized by solid, space-occupying masses, usually found in the brain. It has been reported in the setting of "paradoxical" immune reconstitution inflammatory syndrome. A case of retroperitoneal cryptococcoma in a HIV-infected woman with a clinical history of disseminated cryptococcosis on antifungal maintenance therapy is described.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Antifúngicos/administración & dosificación , Criptococosis/diagnóstico , Criptococosis/patología , Espacio Retroperitoneal/microbiología , Espacio Retroperitoneal/patología , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/patología , Biopsia , Criptococosis/tratamiento farmacológico , Femenino , Histocitoquímica , Humanos , Microscopía , Persona de Mediana EdadAsunto(s)
Traumatismos Abdominales/complicaciones , Miositis/complicaciones , Choque Séptico/etiología , Infecciones Estreptocócicas/etiología , Streptococcus pyogenes/aislamiento & purificación , Heridas no Penetrantes/complicaciones , Traumatismos Abdominales/diagnóstico , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Humanos , Laparoscopía , Masculino , Miositis/diagnóstico , Miositis/cirugía , Espacio Retroperitoneal/microbiología , Choque Séptico/diagnóstico , Choque Séptico/terapia , Fútbol/lesiones , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/terapia , Tomografía Computarizada por Rayos X , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/cirugía , Adulto JovenRESUMEN
INTRODUCTION: Surgical debridement is the mainstay in the management of infected pancreatic necrosis. Minimally invasive techniques have been shown to minimize surgical insult. We aim to review our recent experience with minimally invasive retroperitoneal pancreatic necrosectomy (MIRP). METHODS: The medical records of consecutive patients between October 2007 and April 2008 who underwent MIRP at our hospital were reviewed. All the patients had a preoperative computed tomography-guided aspiration and positive bacteriologic culture of the peripancreatic collection. RESULTS: Five patients underwent MIRP during the 8-month period. Fourteen procedures were carried out, with a median of 3 (range, 1 to 5) procedures per patient. Only 1 patient required postoperative intensive care monitoring. One patient had a left renal contusion that resolved, and 2 patients developed pancreatic fistula owing to pancreatic duct disruption requiring stenting of the pancreatic duct. There were no mortalities. CONCLUSION: MIRP is a good alternative technique in the management of selected patients with infected peripancreatic necrosis.
Asunto(s)
Procedimientos Quirúrgicos Mínimamente Invasivos , Páncreas/cirugía , Pancreatitis Aguda Necrotizante/cirugía , Adulto , Anciano , Desbridamiento/métodos , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Páncreas/microbiología , Pancreatitis Aguda Necrotizante/tratamiento farmacológico , Pancreatitis Aguda Necrotizante/microbiología , Espacio Retroperitoneal/microbiología , Espacio Retroperitoneal/cirugíaRESUMEN
Cat scratch disease (CSD) is usually diagnosed in patients presenting with regional lymphadenopathy and pyrexia that follow contacts with animals. We describe here a young adult male patient who presented with marked pyrexia and a retroperitoneal abscess without relevant medical histories, illustrating that CSD can be a diagnostic challenge on selected occasions.
Asunto(s)
Absceso Abdominal/microbiología , Bartonella henselae/aislamiento & purificación , Enfermedad por Rasguño de Gato/diagnóstico , Absceso Abdominal/sangre , Absceso Abdominal/diagnóstico por imagen , Absceso Abdominal/cirugía , Anticuerpos Antibacterianos/sangre , Enfermedad por Rasguño de Gato/sangre , Enfermedad por Rasguño de Gato/diagnóstico por imagen , Enfermedad por Rasguño de Gato/microbiología , Humanos , Laparoscopía , Escisión del Ganglio Linfático , Ganglios Linfáticos/microbiología , Ganglios Linfáticos/patología , Masculino , Radiografía , Espacio Retroperitoneal/diagnóstico por imagen , Espacio Retroperitoneal/microbiología , Adulto JovenRESUMEN
We present a case of abdominal and retroperitoneal actinomycosis, clinicaly evidenced by a large tumor in the left inferior abdominal quadrant, in a 72-year-old male. Following clinical and laboratory investigations (imaging), strong suspicion of a left colon neoplasm was raised. Surgery consisted in an exploratory laparotomy and multiple biopsies of the great omentum and retroperitoneal space, the case being considered above the therapeutic resources. Histopathological diagnosis was a surprise by setting actinomycotic etiologies and enabled the establishment of a proper antibiotic treatment, followed by a favorable evolution. Postoperative follow-up revealed disappearance of lesions and healing.