Giant retroperitoneal abscess following necrotizing pancreatitis treated with internal drainage

BACKGROUND:Retroperitoneal abscess is a dangerous complication of the inflammatory process in organs. The pancreas reacts by enzymatic autodigestion and inflammation to external and internal factors:alcohol abuse,trauma,biliary stones,and viral infections. Chronic pancreatitis and formation of pseudocysts are late complications.The diffuse spread of pancreatic inflammation may form a retroperitoneal phlegmon.A better outcome is the limitation of the process by capsule formation-retroperitoneal abscess. METHODS:A 62-year-old man,with a history of alcohol abuse,was admitted for intermittent abdominal pain,fever, and significant weight loss.Previous medical consultations (laboratory tests,US,CT)confirmed chronic pancreatitis with pseudocyst formation.A new CT depicted a giant retroperitoneal abscess. RESULTS:After preoperative preparation with antibiotics, laparotomy and internal drainage-longitudinal cystoje- junostomy with Roux-en-Y loop were performed.At the 8th postoperative day the patient was in good condition. CONCLUSIONS:Giant retroperitoneal abscess is a dangerous pathology with significant mortality and morbidity.Diagnosis strongly necessitates operative intervention in order to evacuate and drain the space.Theseconditions include one internal drainage(in the GI tract) with the stomach,duodenum,or jejunum,which does not cause early and late GI discomfort and will gradually liquidate the cavity.We propose internal drainage with Roux-en-Y jejunal loop as the only method for accomplishing these conditions in cases of giant retroperitoneal abscesses.

Extensive retroperitoneal and right thigh abscess in a patient with ruptured retrocecal appendicitis:An extremely fulminant form of a common disease

As a disease commonly encountered in daily practice, acute appendicitis is usually diagnosed and managed easily with a low mortality and morbidity rate. However, acute appendicitis may occasionally become extraordinarily complicated and life threatening. A 56-year-old man, healthy prior to this admission, was brought to the hospital due to spiking high fever, poor appetite, dysuria, progressive right flank and painful swelling of the thigh for 3 d. Significant inflammatory change of soft tissue was noted, involving the entire right trunk from the subcostal margin to the knee joint. Painful disability of the right lower extremity and apparent signs of peritonitis at the right lower abdomen were disclosed. Laboratory results revealed leukocytosis and an elevated C-reactive protein level. Abdominal CT revealed several communicated gas-containing abscesses at the right retroperitoneal region with mass effect, pushing the duodenum and the pancreatic head upward, compressing and encasing inferior vena cava, destroying psoas muscle and dissecting downward into the right thigh. Laparotomy and right thigh exploration were performed immediately and about 500 mL of frank pus was drained. A ruptured retrocecal appendix was the cause of the abscess. The patient fully recovered at the end of the third post-operation week. This case reminds us that acute appendicitis should be treated carefully on an emergency basis to avoid serious complications. CT scan is the diagnostic tool of choice, with rapid evaluation followed by adequate drainage as the key to the survival of the patient.

Appendicitis with psoas abscess successfully treated by laparoscopic surgery

Although acute appendicitis is a common disease, retroperitoneal abscesses are rarely observed. Here, we report a case consisting of a psoas abscess and cutaneous fistula caused by appendicitis. The patient was a 56-year-old male who was introduced to our institution due to an intractable right psoas abscess. Imaging tests had been performed over the previous 3 years; however, clinicians could not find the origin of the abscess and failed to resolve the problem. A successful operation was performed via a laparoscopic approach, and 17 mo have passed without recurrence. The advantage of laparoscopic surgery is well understood in cases of appendicitis with abscesses. However, the indication for laparoscopic approach is not clear for retroperitoneal abscesses. From our experience, we can conclude that appendicitis with retroperitonealabscesses can be managed and treated using a laparoscopic approach.