Acil Serviste Dev Retroperitoneal Bir Abse'nin Değerlendirilmesi: Nadir Raslanan Bir Olgu Sunumu

Year 2016, Volume: 13 Issue: 2, 169 - 175, 29.08.2016

Uğur Lok , Hasan Büyükaslan , Umut Gülaçtı , Hacı Polat İrfan Aydın

Abstract

Retroperitoneal bölgenin enfeksiyonları belirsiz sinsi semptomlar ve nonspesifik klinik bulgu ve
semptomlar nedeniyle tanı konulması zordur. Retroperitoneal abse acil serviste nadiren karşılaşılan
potansiyel olarak hayatı tehdit edici intra-abdominal enfeksiyondur. Etyolojik olarak primer ve sekonder
olarak ikiye ayrılır. En yaygın nedenleri üriner sistem enfeksiyonları, gastrointestinal sisteme ait hastalıklar,
vertebra ve böbrek tüberkülozudur. Daha az görülen nedenleri arasında kemik enfeksiyonları, travma, uzak
enfeksiyonlardan hematojen yolla yayılım ve kanser hastalıklarını içerir. Biz burada 51 yaşında mental
retardasyonlu, başka ek hastalığı bulunmayan, tanı konulamamış ve etiyolojisi belirlenemeyen dev bir
retroperitonel abseli hastayı tartıştık. Sonuç olarak bu tür hastaların zamanında tanı ve tedavisi için yüksek
şüphe endeksi gereklidir özellikle mental retardasyon da bulunuyorsa. 

Keywords

Retroperitoneal Abse, Batın bigisayarlı tomografisi, AcilServis

Assessment of a Giant Retroperitoneal Abscess in Emergency Department: An Unusual Case Presentation

Abstract

Retroperitoneal abscess (RA) is an unusual but potentially life-threatening intra abdominal infections which
is rarely encountered in emergency departments (ED) (1,2). Insidious clinical manifestations and occult
nature of abscess make it diagnostic challenge and causes delays and missed diagnosis that leads to
prolonged sepsis, and increased morbidity and mortality rates (3,4). Retroperitoneal abscess may be
classified as primary if the infection results from hematogenous spread or secondary if they are related to an
infection in an adjacent organ. In a small percent RA may be idiopathic (4,5) which infections may be
monomicrobial but are in most cases polymicrobial (4). Most commonly origin of abscess is primarily
urinary tract infection, followed in frequency bowel-related diseases such as diverticulitis (1,6),
retroperitoneal appendicitis, pancreatitis, biliary, and peptic ulcer diseases spinal and renal tuberculous
disease(3). But cases have been described resulting from bone infections, trauma, hematogenous spread and
malignancies(2,4). The most commonly isolated pathogens are gram-negative bacilli such as Escherichia
coli and Proteus mirabilis in frequency, but anaerobic species such as Bacteroides may also be found Grampositive
cocci, mainly staphylococcal species and rarely streptococcal species, are usually isolated in cases
of hematogenous spread(4). Manifest clinical symptoms include fever, abdominal and/or flank pain, lumbar
mass, weakness, weight loss and anorexia (4). Mainly predisposing factors are diabetes mellitus and
immunocompromised hosts (7). The most reliable and sensitive diagnosis tool remains Computed
tomography CT scan (4,8). The treatment modalities consist of open surgery, percutaneous drainage and
accompanied intravenous antibiotic administration (1,4).
We reported here a case of RA secondary to unknown etiology in a patient with mentally retarded, whose
specification was delayed for weeks before it diagnosed and reached huge size.

Keywords

Retroperitoneal Abscess, Abdominal computed tomography, Emergency Department

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