A 10-year Institutional Retrospective Analysis of Retroperitoneal Abscess

Background: Retroperitoneal Abscess (RA) is a rare and often insidious disease, i.e., difficult to diagnose. RA could originate from different retroperitoneal or intra-abdominal organs. The disease manifests various clinical symptoms and is usually treated with a combination of antibiotics and therapeutic interventions. Methods: Data from a total of 25 patients who were admitted to Loghman Hospital in Tehran City, Iran with a diagnosis of RA from 2010 to 2020 were reviewed in this research. Clinical findings, diagnostic tools, treatment approaches, and microbiology data were considered and analyzed. Results: Out of the 25 patients, the most frequent sources of RA were primary infections (36%), followed by gastrointestinal origin (20%). Fifty-two percent of patients presented no underlying disease; however, diabetes mellitus was the most prevalent underlying disease in the remaining ones. Fever, chills, and back or flank pain (56%) were the most common symptoms in the studied patients. Besides, a high erythrocyte sedimentation rate (mean: 93.58%) was found in most of the researched patients. Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) could reliably diagnose the disease with an accuracy of 100% and 92.3%, respectively. Seventy-two percent of the study patients eventually underwent surgery. By taking advantage of CT scan, 24% of abscesses were drained and only 4% required medications to achieve remission. Mycobacteria and Klebsiella pneumonia were the most prevalent pathogens among the explored patients. The total mortality rate was equal to 12%; it occurred in cases with RA of a gastrointestinal (8%) or genitourinary (4%) origin. Conclusion: There exist 3 major choices for treating abscesses, including surgery, image-guided percutaneous drainage, and medical therapy. Image-Guided drainage is recommended in primary infections; however, extra-peritoneal surgery is useful to treat secondary infections, especially those of a gastrointestinal source.