Retroperitoneal abscess

Brook I, Frazier EH. Aerobic and anaerobic microbiology of retroperitoneal abscesses. Clin Infect Dis 1998 26 938-941. 

Fig. 12.6a-e. Perforation of peptic ulcer. Contrast enhanced CT (CECT) images in five different cases demonstrating a free air anterior to the stomach and free air and fluid in the lesser sac due to perforation of posterior gastric wall ulcer b free intraabdominal air and fluid due to perforation of anterior duodenal bulb ulcer c free air due to duodenal ulcer perforation (arrow) d free air extending into the anterior abdominal wall due to perforation of a duodenal ulcer e retroperitoneal abscess complicating perforation of a posterior duodenal ulcer... 

Intraabdominal infections are those contained within the peritoneum or retroperitoneal space. Two general types of intraabdominal infections are discussed throughout this chapter peritonitis and abscess. 

Table 42-1 summarizes many of the potential causes of bacterial peritonitis. The causes of intraabdominal abscess somewhat overlap those of peritonitis and, in fact, both may occur sequentially or simultaneously. Appendicitis is the most frequent cause of abscess. Intraabdominal infection results from entry of bacteria into the peritoneal or retroperitoneal spaces or from bacterial collections within intraabdominal organs. When peritonitis results from peritoneal dialysis, skin surface flora are introduced via the peritoneal catheter. 

The surgical approach depends on the location of the abscess, any abdominal investigation that may be required, and possible sanitization of a focus. The respective access routes are .) transperitoneal, (2.) extraperitoneal, (i.) in special cases also retroperitoneal or infrapleural, and (4.) transpleural as well as transdia-... 

Although rare, dissection or perforation of the renal arteries and their branches can occur. Rupture may lead to rapid development of retroperitoneal hemorrhage. Both dissection flaps and rupture can be immediately controlled with balloon tamponade. Although dissection flaps can often be tacked down, rupture typically requires emergent surgery. Even perforation of smaller branch vessels can occur if a guidewire is passed too far into the periphery. Hematoma and abscess can develop. 

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