Fournier Gangrene as a Complication of a Perinephric Abscess After Kidney Transplant: A Case Report.

Fournier gangrene is a progressive necrotizing infection of the external genitalia or perineum that constitutes a urologic emergency. Incidence of Fournier gangrene is rising because of population aging, increasing comorbidities, and widespread use of immunosuppressive therapy, including immunosuppressive regimens used in kidney transplants. This is a rapidly progressive and potentially lethal disease without treatment, and early recognition of the disease, proper management of the predisposing factors, and aggressive surgical debridement are the most essential interventions. We report a rare case of Fournier gangrene in the early postoperative period of a kidney transplant due to a perinephric abscess.

Inflammatory myofibroblastic tumor of kidney together with ipsilateral perinephric and periureteric fibrosis: A case report and literature review.

RATIONALE: Both inflammatory myofibroblastic tumor (IMT) and retroperitoneal fibrosis are rare lesions, but kidney involvement is more rare. It is the first study about IMT of the kidney in a patient with perinephric and periureteric fibrosis and we hold that fibroblast proliferation may be an intermediate status in oncogenesis of IMT. But further investigation is necessary in order to better clarify the relationship between fibroblast proliferation and IMT. PATIENT CONCERNS: A 54-year-old female presented no positive signs except dull back pain after overwork. DIAGNOSES: On the basis of the urinary ultrasonography and computed tomography (CT) scan, we strongly suspected a renal cell carcinoma. INTERVENTIONS: Considering the little remaining function of the right kidney and the possibility of malignancy, we performed a laparoscopic right radical nephrectomy. OUTCOMES: According to the analysis of the postoperative paraffin section and immunohistochemistry assay, a final diagnosis of IMT and retroperitoneal fibrosis nodules was made. LESSONS: Both IMTs are rare lesions and its etiology and pathogeny are unclear. It is the first study about IMT of the kidney in a patient with perinephric and periureteric fibrosis. This report suggested that fibroblast proliferation may be an intermediate status in oncogenesis of IMT, but further investigation is necessary in order to better clarify the relationship between fibroblast proliferation and IMT. The preoperative diagnosis of renal IMT remains difficult. Preoperative fine-needle aspiration or percutaneous biopsy and intraoperative frozen section were applied to confirm the diagnosis to avoid unnecessary nephrectomy, especially in patients with renal insufficiency, bilateral masses, or a solitary kidney.

Current treatment and outcomes of perinephric abscesses.

PURPOSE: We characterize the treatment and outcomes of perinephric abscesses in a contemporary cohort of patients. MATERIALS AND METHODS: We reviewed the experience with perinephric abscesses at a single community based hospital. Abdominal computerized tomography (CT) was widely available during the study period and experience with radiographic guided percutaneous drainage was extensive. Therapy and intervention for individual patients were dictated by the treating physician. RESULTS: Of the 25 patients identified with perinephric abscesses 3 (12%) ultimately died. Although 40% had multiple risk factors for perinephric abscesses only 35% were identified at presentation. Urine cultures were positive in 72% of patients and CT had a diagnostic sensitivity of 92%. Ten patients with a mean abscess size of 1.8 cm. were treated with antibiotics alone (mean hospitalization 10 days) while 11 with a mean abscess size of 11 cm. received antibiotics and initial percutaneous drainage (mean hospitalization 30 days). Of the 11 patients treated with percutaneous drainage 4 ultimately required surgical exploration and nephrectomy. CONCLUSIONS: The clinical characteristics of perinephric abscesses have not changed significantly but improved imaging with CT allows earlier diagnosis and treatment, which likely contributed to the reduced mortality in our cohort compared to historical series. With accurate staging and careful followup, a variety of treatments can be successful, including antibiotics alone or in conjunction with percutaneous drainage and urinary drainage. Open surgical drainage and nephrectomy may eventually be required in some patients and should be considered if adequate drainage is not achieved.

Resección de tumores retroperitoneales / Retroperitoneal tumors resection

Antecedentes: Los Tumores Retroperitoneales (TRP), constituyen entidades de escasa observación, frecuentemente malignas y, generalmente, de diagnóstico tardío. Su exéresis completa obliga, asiduamente, a resecar órganos vecinos. Objetivo: Analizar las resecciones de TRP realizadas personalmente durante 5 años (1992 a 1996). Lugar de Aplicación: Hospital Angel C. Padilla y práctica privada. Diseño: Estudio retrospectivo. Material y Métodos: se analizan 9 resecciones de TRP en ocho pacientes, cuatro de ellos mujeres. Tres de los diagnósticos fueron intraoperatorios, en tumores benignos; los restantes, clínico, ecográfico y tomográfico. Resultados: No hubo mortalidad peri-operatoria. Las resecciones de lesiones benignas fueron completas. 5 de 8 pacientes presentaban Sarcomas; 4 requirieron resección de órganos vecinos, incluyendo colon izquierdo, bazo y riñón derecho. 3 de 5 Sarcomas fueron Liposarcomas. Ninguno fue considerado irresecable. Conclusiones: Se han resecado ocho TRP primitivos y uno recidivado. Hallazgo intraoperatorio: dos casos. Los restantes se diagnosticaron con Ecografía y TAC. Los Sarcomas representaron 5 de 8 pacientes; de ellos, 3 fueron Liposarcomas. Los dos restantes fueron Condrosarcoma y Fibrohistiocitoma maligno. Un Liposarcoma fue reoperado antes de los 8 meses por recidiva; pero globalmente haan mostrado mejor respuesta al tratamiento. Los dos fallecidos por sus tumores fueron portadores de las otras formas histológicas. La resección de vísceras vecinas fue necesaria en 4 de 5 Sarcomas, no siempre relacionadas con el volumen. Se resecaron colon izquierdo, bazo y riñón derecho. (AU)

Page kidney with constrictive perinephritis.

We describe a case of Page kidney following an infectious urinoma complicated by a pyelolithotomy. The most characteristic finding was the fact that this case resulted from constrictive perinephritis, not from any usual etiology such as perirenal hematoma. Knowledge of the patient's medical history and split venous renin measurements were helpful in making a diagnosis. She had refractory hypertension during conservative medical therapy. Finally, a nephrectomy improved her hypertension. The value of venous renin sampling for reaching a diagnosis, and the medical and surgical therapeutic options are discussed. This report also reviews all previously described cases of Page kidney without hematomas.

[Perinephritic abscess]. / Perinefrittisk abscess.

In spite of technical advances in diagnostic radiology the recognition of a perinephric abscess is still a challenge to even the most experienced urologist. Untreated perinephric abscesses result in considerable mortality. We present ten years experience from 17 patients. All underwent open drainage procedures. In our case this still seems to be the treatment of choice for the majority of these patients. Percutaneous drainage is an alternative to surgery, and is particularly suitable for the high risk patient.

Splenic abscess arising by direct extension from a perinephric abscess.

A case of a perinephric abscess invading the spleen in a 25-year-old woman with bladder exstrophy is reported. Treatment utilized both percutaneous drainage and open surgery. Perinephric abscesses have not been previously reported to extend into the spleen.

Abscesos perinefríticos / Perinephritic abscess

Analizamos 30 casos de abscesos perinefríticos tratados en el Hospital del Salvador; se discuten valor de exámenes complementarios, el diagnóstico y resultados terapéuticos, haciendo énfasis en la ecografía como procedimiento diagnóstico y la punción percutánea como tratamiento en aquellos casos que no haya compromiso renal

[Tomodensitometry in the diagnosis of perinephritic phlegmon]. / Apport de la tomodensitométrie dans le diagnostic des phlegmons périnéphrétiques.

Twenty-nine patients with perinephric abscess were treated during the last 15 years. Twenty-seven abscesses were cured by drainage performed as soon as the diagnosis has been made. One patient died from septicemia in spite of the treatment. One patient died because the correct diagnosis was not revealed until the autopsy. Ten patients had a nephrectomy performed on them later on. Staphylococcus and gram negative bacilli were equally isolated. Stones were present in twenty patients. Eleven patients were diabetic. The clinical picture is not always clear, and diagnosis might be difficult. The different radiological signs help to reach a correct and prompt diagnosis. To these classical signs we can add during these last years Gallium-67 radionuclide studies, ultrasound and computerized tomography, each of these having its indication and usefulness.

[Perinephritic abscesses: a review of 50 cases (author's transl)]. / Abscesos perinefríticos: revisión de 50 casos.

Accumulation of pus in the perinephritic cavity often gives rise to doubtful clinical manifestations, which hinder and delay prompt diagnosis of this severe process. The clinical, biological, radiological and therapeutic characteristics of 50 cases are reviewed; all were confirmed by either surgery or necropsy. The most frequent clinical manifestations were fever, lumbar pain and signs of localized inflammation. Biological data showed ESR elevation and left shift of leukocytes as the most constant finding. Pyelograms were abnormal in 90% with blurring of the psoas and contour of the kidney the most frequent finding. Gram-negative organisms were frequently isolated, with staphylococci accounting for 10%. Only surgical treatment had a definite effect on evolution. The mortality rate was high, due to incorrect or delayed diagnosis.