A Giant Retroperitoneal Abscess Mimicking Incarcerated Inguinal Hernia

An 82-year-old man was admitted to the emergency room with an\udacute left-sided groin pain and scrotal swelling. He has suffered\udfrom a groin hernia for two years. Abdominal x-ray demonstrated\udair-fluid levels in the left upper quadrant suggesting an intestinal\udobstruction (Figure 1). Abdominal computed tomography (CT)\udscan was obtained with an initial diagnosis of an incarcerated\udinguinal hernia. However, it showed multiple perirenal abscesses\udand a giant-sized retroperitoneal abscess extending from the\udretroperitoneal space into the scrotum through the inguinal canal\ud(Figure 2 and 3).\udRetroperitoneal abscesses are most frequently seen in the 3rd to\ud6th decades of life (1). Gram-negative bacteria, most commonly E.\udcoli, are the cause of infection which usually develops secondary to\udpyelonephritis, urinary stasis or immune suppression. The onset of\udclinical manifestations of the infection, including flank, abdomen\udand groin pain, chills, fever, tachycardia, weakness and anorexia\udare often insidious (2,3). Laboratory findings include leukocytosis,\udincreased serum creatinine levels and pyuria. The literature\udemphasizes the possibility of diagnostic delay and postponed\udtreatment of retroperitoneal abscess due to the fact that its\udprodrome phase may be long