Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1987 Mar;205(3):276–281. doi: 10.1097/00000658-198703000-00010

Management and outcome of retroperitoneal abscesses.

J T Crepps, J P Welch, R Orlando 3rd
PMCID: PMC1492717  PMID: 3827363

Abstract

Retroperitoneal space abscesses are unusual clinical problems encountered by general surgeons, internists, and surgical subspecialists. An insidious, occult illness marked by diagnostic delay, inadequate drainage, and considerable morbidity and mortality is common. Anatomic reviews detailing the complex extraperitoneal spaces have been published, but less attention has been focused on diagnostic and drainage techniques useful to the practicing surgeon. In a retrospective review of 50 extraperitoneal abscesses, attention was directed to clinical presentation, diagnosis, and therapy. On the average, 12.7 days were required to establish the diagnosis; 50% of patients suffered major complications. A strikingly high mortality was associated with positive blood cultures and persistent fever within 48 hours of drainage (75% and 71%, respectively). Computed tomography has greatly enhanced the diagnosis of extraperitoneal abscesses, and radiologic drainage in selected cases appears to be a useful initial approach. A simplified anatomic classification and treatment plan is proposed to facilitate comparison between clinical series.

Full text

PDF
276

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ALTEMEIER W. A., ALEXANDER J. W. Retroperitoneal abscess. Arch Surg. 1961 Oct;83:512–524. doi: 10.1001/archsurg.1961.01300160024004. [DOI] [PubMed] [Google Scholar]
  2. Anderson R. B., Gatter R. A. Hip pain in patient with Crohn's disease. Occult retroperitoneal abscess as cause. Postgrad Med. 1984 Apr;75(5):117-8, 120, 124. doi: 10.1080/00325481.1984.11697995. [DOI] [PubMed] [Google Scholar]
  3. Blumenthal D. H., Morin M. E., Tan A., Li Y. P. Intestinal penetration by tuberculous psoas abscess. AJR Am J Roentgenol. 1981 May;136(5):995–997. doi: 10.2214/ajr.136.5.995. [DOI] [PubMed] [Google Scholar]
  4. Borten M., Friedman E. A. Spontaneous prevesical (Retzius-space) abscess with extraperitoneal presacral dissemination. A case report. J Reprod Med. 1984 Nov;29(11):841–844. [PubMed] [Google Scholar]
  5. Brolin R. E., Nosher J. L., Leiman S., Lee W. S., Greco R. S. Percutaneous catheter versus open surgical drainage in the treatment of abdominal abscesses. Am Surg. 1984 Feb;50(2):102–108. [PubMed] [Google Scholar]
  6. Budnick L. D. Toothpick-related injuries in the United States, 1979 through 1982. JAMA. 1984 Aug 10;252(6):796–797. [PubMed] [Google Scholar]
  7. Burul C. J., Ritchie J. K., Hawley P. R., Todd I. P. Psoas abscess: a complication of Crohn's disease. Br J Surg. 1980 May;67(5):355–356. doi: 10.1002/bjs.1800670519. [DOI] [PubMed] [Google Scholar]
  8. Cockerill F. R., 3rd, Wilson W. R., Van Scoy R. E. Traveling toothpicks. Mayo Clin Proc. 1983 Sep;58(9):613–616. [PubMed] [Google Scholar]
  9. Donovan P. J., Zerhouni E. A., Siegelman S. S. cT of the psoas compartment of the retroperitoneum. Semin Roentgenol. 1981 Oct;16(4):241–250. doi: 10.1016/0037-198x(81)90024-9. [DOI] [PubMed] [Google Scholar]
  10. Faerber E. N., Leonidas J. C., Leape L. L. Retroperitoneal iliac abscess with periostitis. AJR Am J Roentgenol. 1981 Apr;136(4):828–829. doi: 10.2214/ajr.136.4.828. [DOI] [PubMed] [Google Scholar]
  11. Feldberg M. A., Koehler P. R., van Waes P. F. Psoas compartment disease studied by computed tomography. Analysis of 50 cases and subject review. Radiology. 1983 Aug;148(2):505–512. doi: 10.1148/radiology.148.2.6867350. [DOI] [PubMed] [Google Scholar]
  12. Finnerty R. U., Vordermark J. S., 2nd, Modarelli R. O., Buck A. S. Primary psoas abscess: case report and review of literature. J Urol. 1981 Jul;126(1):108–109. doi: 10.1016/s0022-5347(17)54402-x. [DOI] [PubMed] [Google Scholar]
  13. Firor H. V. Acute psoas abscess in children. Clin Pediatr (Phila) 1972 Apr;11(4):228–231. doi: 10.1177/000992287201100409. [DOI] [PubMed] [Google Scholar]
  14. Gerzof S. G., Robbins A. H., Birkett D. H., Johnson W. C., Pugatch R. D., Vincent M. E. Percutaneous catheter drainage of abdominal abscesses guided by ultrasound and computed tomography. AJR Am J Roentgenol. 1979 Jul;133(1):1–8. doi: 10.2214/ajr.133.1.1. [DOI] [PubMed] [Google Scholar]
  15. Hardcastle J. D. Acute non-tuberculous psoas abscess. Report of 10 cases and review of the literature. Br J Surg. 1970 Feb;57(2):103–106. doi: 10.1002/bjs.1800570206. [DOI] [PubMed] [Google Scholar]
  16. Harris L. F., Sparks J. E. Retroperitoneal abscess. Case report and review of the literature. Dig Dis Sci. 1980 May;25(5):392–395. doi: 10.1007/BF01308066. [DOI] [PubMed] [Google Scholar]
  17. Hibbard L. T., Snyder E. N., McVann R. M. Subgluteal and retropsoal infection in obstetric practice. Obstet Gynecol. 1972 Jan;39(1):137–150. [PubMed] [Google Scholar]
  18. Jacob H., Rubin K. P., Cohen M. C., Kahn I. J., Kan P. Gallstones in a retroperitoneal abscess: a late complication of perforation of the gallbladder. Dig Dis Sci. 1979 Dec;24(12):964–966. doi: 10.1007/BF01311955. [DOI] [PubMed] [Google Scholar]
  19. Jeffrey R. B., Callen P. W., Federle M. P. Computed tomography of psoas abscesses. J Comput Assist Tomogr. 1980 Oct;4(5):639–641. doi: 10.1097/00004728-198010000-00013. [DOI] [PubMed] [Google Scholar]
  20. Kraybill W. G., Reinsch J., Puckett C. L., Bricker E. M. Pelvic abscess following preoperative radiation and abdominoperineal resection: management with a free flap. J Surg Oncol. 1984 Jan;25(1):18–20. doi: 10.1002/jso.2930250106. [DOI] [PubMed] [Google Scholar]
  21. Kyle J. Psoas abscess in Crohn's disease. Gastroenterology. 1971 Aug;61(2):149–155. [PubMed] [Google Scholar]
  22. Lam S. F., Hodgson A. R. Non-spinal pyogenic psoas abscess. J Bone Joint Surg Am. 1966 Jul;48(5):867–877. [PubMed] [Google Scholar]
  23. Lombrozo R., Wolloch Y., Dintsman M. Retroperitoneal dissection of a pancreatic pseudocyst to the left inguinal region. Isr J Med Sci. 1977 Mar;13(3):309–312. [PubMed] [Google Scholar]
  24. Maull K. I. Extraperitoneal abscess. Am Surg. 1980 Aug;46(8):453–456. [PubMed] [Google Scholar]
  25. Maull K. I., Sachatello C. R. Retroperitoneal iliac fossa abscess: a complication of suppurative iliac lymphadenitis. Am J Surg. 1974 Mar;127(3):270–274. doi: 10.1016/0002-9610(74)90030-0. [DOI] [PubMed] [Google Scholar]
  26. Meyers M. A. Acute extrapitoneal infection. Semin Roentgenol. 1973 Oct;8(4):445–464. doi: 10.1016/0037-198x(73)90114-4. [DOI] [PubMed] [Google Scholar]
  27. Morgan W. R., Nyberg L. M., Jr Perinephric and intrarenal abscesses. Urology. 1985 Dec;26(6):529–536. doi: 10.1016/0090-4295(85)90353-x. [DOI] [PubMed] [Google Scholar]
  28. O'Keefe T. J. Retroperitoneal abscess. A potentially fatal complication of closed fracture of the pelvis. J Bone Joint Surg Am. 1978 Dec;60(8):1117–1121. [PubMed] [Google Scholar]
  29. Peterson C. M., Allison J. G., Lu C. C. Psoas abscess resulting from perforating carcinoma of the sigmoid colon. Report of a case. Dis Colon Rectum. 1983 Jun;26(6):390–392. doi: 10.1007/BF02553381. [DOI] [PubMed] [Google Scholar]
  30. Qureshi H., Ahmed M. Retroperitoneal abscesses--case reports. J Pak Med Assoc. 1981 May;31(5):108–111. [PubMed] [Google Scholar]
  31. Ravo B., Khan S. A., Ger R., Mishrick A., Soroff H. S. Unusual extraperitoneal presentations of diverticulitis. Am J Gastroenterol. 1985 May;80(5):346–351. [PubMed] [Google Scholar]
  32. Ricci M. A., Meyer K. K. Psoas abscess complicating Crohn's disease. Am J Gastroenterol. 1985 Dec;80(12):970–977. [PubMed] [Google Scholar]
  33. Rosenberg D., Baskies A. M., Deckers P. J., Leiter B. E., Ordia J. I., Yablon I. G. Pyogenic sacroiliitis. An absolute indication for computerized tomographic scanning. Clin Orthop Relat Res. 1984 Apr;(184):128–132. [PubMed] [Google Scholar]
  34. Rubenstein W. A., Auh Y. H., Zirinsky K., Kneeland J. B., Whalen J. P., Kazam E. Posterior peritoneal recesses: assessment using CT. Radiology. 1985 Aug;156(2):461–468. doi: 10.1148/radiology.156.2.4011911. [DOI] [PubMed] [Google Scholar]
  35. Saksouk F. A., Tipton-Donovan A., Amis E. S., Jr, Goldman S. M. Computed tomography of perirenal and pararenal inflammatory disease complicating renal calculi. Urology. 1984 Aug;24(2):200–204. doi: 10.1016/0090-4295(84)90432-1. [DOI] [PubMed] [Google Scholar]
  36. Shi E. C., Yeo B. W., Ham J. M. Pancreatic abscesses. Br J Surg. 1984 Sep;71(9):689–691. doi: 10.1002/bjs.1800710914. [DOI] [PubMed] [Google Scholar]
  37. Simons G. W., Sty J. R., Starshak R. J. Retroperitoneal and retrofascial abscesses. A review. J Bone Joint Surg Am. 1983 Oct;65(8):1041–1058. [PubMed] [Google Scholar]
  38. Simons G. W., Sty J. R., Starshak R. R. Iliacus abscess. Clin Orthop Relat Res. 1984 Mar;(183):61–63. [PubMed] [Google Scholar]
  39. Stevenson E. O., Ozeran R. S. Retroperitoneal space abscesses. Surg Gynecol Obstet. 1969 Jun;128(6):1202–1208. [PubMed] [Google Scholar]
  40. Svancarek W., Chirino O., Schaefer G., Jr, Blythe J. G. Retropsoas and subgluteal abscesses following paracervical and pudendal anesthesia. JAMA. 1977 Feb 28;237(9):892–894. [PubMed] [Google Scholar]
  41. Sykes J. T., Sage M. R., Burke A. M. Computed tomography in the diagnosis of iliopsoas abscesses. Med J Aust. 1984 Apr 14;140(8):492–493. doi: 10.5694/j.1326-5377.1984.tb108172.x. [DOI] [PubMed] [Google Scholar]
  42. Turner G., Daniell S. J. Lumbar abscess resulting from appendicitis. J R Soc Med. 1984 Oct;77(10):884–887. doi: 10.1177/014107688407701016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Van Dongen L. M., Lubbers E. J. Psoas abscess in Crohn's disease. Br J Surg. 1982 Oct;69(10):589–590. doi: 10.1002/bjs.1800691010. [DOI] [PubMed] [Google Scholar]
  44. Waizbard E., Michowitz M., Baratz M., Papo J., Stavorovsky M. Unusual presentation of carcinoma of the vermiform appendix: a report of two cases. J Surg Oncol. 1984 Apr;25(4):263–267. doi: 10.1002/jso.2930250409. [DOI] [PubMed] [Google Scholar]
  45. Welch J. P. Unusual abscesses in perforating colorectal cancer. Am J Surg. 1976 Mar;131(3):270–274. doi: 10.1016/0002-9610(76)90114-8. [DOI] [PubMed] [Google Scholar]
  46. Wolverson M. K., Jagannadharao B., Sundaram M., Joyce P. F., Riaz M. A., Shields J. B. CT as a primary diagnostic method in evaluating intraabdominal abscess. AJR Am J Roentgenol. 1979 Dec;133(6):1089–1095. doi: 10.2214/ajr.133.6.1089. [DOI] [PubMed] [Google Scholar]
  47. van den Wildenberg F. A. The retrocaecal appendix: a snake in the grass. Neth J Surg. 1982 Jul;34(3):133–135. [PubMed] [Google Scholar]
  48. vanSonnenberg E., Ferrucci J. T., Jr, Mueller P. R., Wittenberg J., Simeone J. F. Percutaneous drainage of abscesses and fluid collections: technique, results, and applications. Radiology. 1982 Jan;142(1):1–10. doi: 10.1148/radiology.142.1.7053517. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES