Symptoms: fever, malaise, diffuse abdominal pain on physical examination, costovertebral tenderness, and a positive "psoas sign" when the psoas muscle is involved. The symptoms will have been present for several weeks and if the retroperitoneal nerves are involved, patients may complain of tenderness in the groin, lower abdomen, flank, and upper thigh. Sepsis is observed in approximately 60 percent of affected patients

Diagnosis

• Laboratory testing is nonspecific and leukocytosis being noted in two thirds of patients. Anemia is often present. Sixty percent of the time, pyuria will be observed. Hematuria is present in approximately thirty percent.
• Routine abdominal x-ray (normal in approximately half the of the patients)
• Abnormalities can include the following:
  • Obliteration of the psoas muscle border on the abscess side
  • Displacement of bowel gas and/or ilcus
  • Lumbar scoliosis
  • Paranephric gas
  • Displacement of the kidney
  • Abdominal ultrasound may be of some diagnostic help
  • CT scan will provide definitive diagnostic detail with regard to the size, content, and magnitude of the retroperitoneal abscess

Medical Treatment

• Combination antibiotic therapy with early drainage
• Traditionally, a surgical incision with irrigation and drainage of the space was the treatment of choice but with the high precision of interventional radiology, percutaneous drainage with one or more tubes has been proven to be highly successful

Surgical Management

• Only those cases with failed resolution of infection should open surgical drainage or nephrectomy be performed

References

• Baker LRI, Mallinson WJ, Gregory MC, et al: Idiopathic retroperitoneal fibrosis: A retrospective analysis of 60 cases. Br J Urol 60:497-503, 1988. Dalton RR, Donohue JH, Mucha P, et al: Management of retroperitoneal sarcomas. Surgery 105:725, 1989.
• Felix EL, Wood DK, DasGupta TK: Tumors of the retroperitoneum. Curr Probl Cancer 6:3, 1981.
• Koep L, Zuidema, GD: The clinical significance of retroperitoneal fibrosis. Surgery 82:250-257, 1977.
• Sheinfeld J, Eturk E, Spatano RF, et al: Peritoneal abscess:Current concepts. J Urol 127:191-194,1987.
• Wagenknect LV, Hardy JC: Value of various treatment for retroperitoneal fibrosis. Eur Urol 7:193-200, 1981.

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