Clinical communication: AdultNecrotizing Fasciitis as the Clinical Presentation of a Retroperitoneal Abscess
Introduction
Infections of the retroperitoneum and psoas sheath may present with insidious symptoms and non-specific clinical signs. These infections commonly present with indolent fevers and chills; weight loss; abdominal, flank, groin, or back pain; malaise; and anorexia. Diagnosis is usually delayed, often for months, or confused with other clinical entities (1, 2). Presentations may be dramatic, with the rapid onset of septic shock or other complications after perforation and release of bacterial contents into the peritoneum, thorax, meninges, and thigh (3, 4, 5, 6, 7). Before the age of antibiotics, spread of infection from tuberculous vertebral osteomyelitis to the lower extremities via the psoas fascia was also common. These complications are now rarely seen due to improved diagnostic and therapeutic modalities. We report a case of retroperitoneal abscess whose diagnosis was delayed for weeks before it developed into a lower extremity necrotizing fasciitis.
Section snippets
Case Report
A 45-year-old man presented to the Emergency Department (ED) with the chief complaint of a painful and swollen left thigh. The pain and swelling began 3 days before presentation, worsening until he was unable to walk. He reported having hit his left thigh several days before presentation, and to having ”fallen in the kitchen” a month earlier, with subsequent left flank and hip pain. In the weeks before presentation, he made two visits to community EDs and was evaluated with plain films of the
Discussion
A rare but life-threatening complication of intra-abdominal infection is extension to the thigh. In the absence of a clear lower extremity origin for soft tissue infection of the thigh, the peritoneum, psoas sheath, and retroperitoneum must be evaluated for occult infection. Historically, retroperitoneal and psoas abscesses were most frequently encountered with tuberculous vertebral osteomyelitis, but cases have been described resulting from appendicitis, ischiorectal abscess, vaginal delivery,
Conclusion
Retroperitoneal and psoas abscesses can occur secondary to a range of abdominal pathologies and are an important differential diagnostic consideration in the evaluation of patients with chronic non-specific complaints. The clinician must aggressively obtain imaging studies in patients with suggestive histories, as physical examination and laboratory evaluation are insensitive for these frequently fatal infections. In cases that progress to necrotizing fasciitis or clostridial gangrene,
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Cited by (13)
Retroperitoneal and cutaneous necrotizing fasciitis secondary to necrotizing pancreatitis
2014, Journal of Emergency MedicineCitation Excerpt :In contrast, retroperitoneal abscesses may present with a much more indolent course of fevers, weight loss, abdominal, back, flank, or groin pain. As a result, diagnosis may be delayed for months (7). Pancreatitis is complicated by pancreatic or retroperitoneal abscess in only about 3% of patients (8).
Necrotizing fasciitis of the thigh secondary to retroperitoneal abscess
2012, American Journal of the Medical SciencesCitation Excerpt :Necrotizing fasciitis is a life-threaten soft-tissue infection that commonly begins at the site of a small insignificant wound or surgical incision. Herein, we demonstrated that retroperitoneal abscess could be an unusual etiology of necrotizing fasciitis of the thigh.1,2 A computed tomography scan establishes the evaluation of the extension of involvement.
Streptococcus mutans: A rare cause of retroperitoneal abscess
2011, Advances in Medical SciencesCitation Excerpt :Streptococcal species are not frequently isolated from retoperitoneal abscesses and a few cases of retroperitoneal abscess from S. pyogenes [10,16], S. pneumonia [3] and S. viridans [14] have been reported. The abscesses from S. pyogenes [10,16] and S. pneumonia [3] were monomicrobial while the abscess from S. viridians was polymicrobial involving isolates of Escherichia coli and Enterococcus faecalis [15]. According to our knowledge this is the first case of a retroperitoneal abscess caused by a monomicrobial infection from S. mutans.
Emphysematous pyelonephritis presenting as necrotizing fasciitis of the leg
2009, Journal of the Chinese Medical AssociationNecrotizing soft tissue infection of the upper leg as first presentation of necrotizing pancreatitis: a case report
2022, Acta Gastro-Enterologica BelgicaNecrotizing fasciitis: A rare complication of acute necrotizing pancreatitis
2017, Journal of Clinical and Diagnostic Research