The occurrence of retroperitoneal abscesses is often secondary to infections of intra-abdominal organs, retroperitoneal organs, the spine or the twelfth rib, pelvic retroperitoneal abscesses, and diseases such as bacteremia. The abscess can spread upward to the mediastinum, descend along the femoral hernia orifice into the thigh, or rupture into the abdominal cavity, gastrointestinal tract, pleura, bronchus, and even form chronic persistent fistulas.

bubble_chart Diagnosis

1. Medical history inquiry

Ask about any history of related organs or areas, trauma, or causes of diseases leading to bacteremia. Systemic toxic symptoms such as unexplained shivering, high fever, sweating, weakness, and weight loss. The most prominent symptom is abdominal or back pain, directly related to the abscess site. Sometimes, bending the thigh or lying on the unaffected side may alleviate the pain. Symptoms such as frequent urination, urgency, and dysuria may also occur.

2. Physical examination findings

The body temperature may show a sustained fever, and the patient may assume a passive flexed position during examination. Abdominal palpation, rectal, or vaginal examination may reveal a tender mass, with generally no rigidity of the abdominal wall. In cases of perirenal abscess, bulging and tenderness in the costovertebral angle, lumbar muscle spasm, and pitting edema of the lumbar skin may be observed. If the iliopsoas muscle is involved, spinal curvature and pain upon extending the ipsilateral thigh may occur. Occasionally, draining sinuses or subcutaneous abscesses may be seen. In severe and diffuse infections, marked abdominal distension, confusion, drowsiness, jaundice, and shock may occur.

Leukocyte count and neutrophil percentage are often significantly elevated. Urinalysis may be normal, but pyuria, proteinuria, and bacteriuria may be present in perirenal abscess cases. Abdominal X-ray may show a soft tissue mass shadow on the affected side, blurred renal outline, and indistinct psoas muscle margin. Sometimes, air-fluid levels at the abscess site, spinal curvature, or intestinal paralysis may be seen. Destruction of lumbar vertebrae or ribs, elevated diaphragm, or pleural effusion may also be observed. Barium meal examination may reveal barium leakage into the abscess cavity, identifying fistulas or sinuses. Ultrasound and CT scans can clearly detect retroperitoneal fluid accumulation. If necessary, fine-needle aspiration guided by ultrasound can confirm the diagnosis.

bubble_chart Treatment Measures

The key lies in early diagnosis. During the suspected diagnosis period, on one hand, enhanced nutritional support therapy should be provided, while on the other hand, anti-infection and anti-shock treatments should be intensified, along with completing various examinations. Once the diagnosis is confirmed, surgical incision and drainage should be performed immediately, with thorough debridement, adequate drainage, and placement of drainage catheters. If necessary, a double-lumen tube should be placed for continuous irrigation and drainage. Both before and after surgery, attention should be paid to correcting water-electrolyte imbalances and acid-base balance disorders.