Retroperitoneal Abscess Resulting from Perforated Acute Appendicitis: Analysis of Its Management and Outcome

Abstract

The formation of complicated retroperitoneal abscesses involving thigh, psoas muscle, perinephric space, or even the lateral abdominal wall is a serious complication of perforated acute appendicitis. An intra-abdominal pathological abnormality cannot be excluded in a patient presenting without abdominal symptoms. The mortality rate can only be reduced by a high index of suspicion, accurate diagnosis, and appropriate treatment.

Paranephricabscess secondary to perforated appendicitis; an abdominal drainage is a rule rather than an option during appendectomy

“…Despite that, we should acknowledge of a low sensitivity of CT scan (42%) in identifying a perforated appendicitis as a cause of RPA. Severe inflammation made the appendix becomes necrotic and indistinguishable from abscess on CT scan [13]. Fortunately, in ours it can be seen quite well.…”

“…Interestingly, midline laparotomy was the preferred approach [1,6,13]. Some authors even approached the abscess retroperitoneally first before proceed with appendectomy for complicated appendicitis as the latter was not suspected initially [11].…”

Retroperitoneal abscess perforating into the thoracic cavity in an immunocompromised host

“…Appendectomy followed by adequate drainage of the abscess was the best treatment. 5 Our patient also had no obvious symptoms, for retroperitoneal abscess mainly because of the steroid administration, which masked the temperature elevation.…”

“…However, the patients were from urology department, so that it could be considered that the original organs tended to be limited to those treated in urology departments. 2 As origin, it could be expected that the appendix or pancreas, which are more often dealt with by general surgeons, would have been rare in the study of Capitán Manjón et al 1 Hsieh et al 5 reported, in a review of PubMed studies of retroperitoneal abscess resulting from perforated acute appendicitis, including the surveillance of 22 patients with acute appendicitis complicated by retroperitoneal abscess, that none of the patients presented with the classical symptoms of acute appendicitis at the onset of the disease, and fewer than half (9/24) reported abdominal pain. Appendectomy followed by adequate drainage of the abscess was the best treatment.…”

Rare Etiological Causes of Iliofemoral Deep Venous Thrombosis: Reports of 2 Cases

“…It was also reported that none of these patients presented with classical signs and symptoms of appendicitis. 5 In another case report presenting femoro-popliteal DVT secondary to left psoas abscess, the difficulty of diagnosing a psoas abscess before clinical use of CT was emphasized. 6 In the literature, it was reported that a psoas abscess can be drained either surgically or percutaneously.…”