Video assisted surgery: a unique approach for non-resolving retroperitoneal abscess

Abstract

Abscesses developing within the retroperitoneal spaces are serious surgical infections which are associated with prolonged morbidity and high mortality unless diagnosed early and treated adequately. These lesions are usually secondary, being complications of infections, injuries, or malignancy of adjacent retroperitoneal or intraperitoneal organs. These abscesses have insidious developments, with symptoms occurring towards the latter phases of the illness. Interestingly they may present with a lack of abdominal signs, and in many cases become apparent once there is an extra-abdominal manifestation. Patients may report referred pain to the lower limb, painful swellings in the groin, or there may be evidence of subcutaneous emphysema on clinical examination. Physical examination usually reveals a chronically ill patient with fever, intermittent and spiking, and associated tachycardia. A mass, when palpable, is tender and is present in the abdomen, flank, and, rarely, in the thigh, groin, or scrotum. Diagnosis is usually made on clinical impression followed by further evaluation by computed tomography. Expeditious diagnosis with the use of abdominal CT scans for anatomic definition of the abscess, combined with adequate surgical drainage and antibiotic support improve survival chances. CT guided percutaneous drainage, at least as a temporizing measure, is suitable for those patients with a high surgical risk.