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Chirurgia 2019 December;32(6):344-51

DOI: 10.23736/S0394-9508.18.04939-2


language: English

Retroperitoneal abscess from perforated acute appendicitis: a diagnostic challenge

Mauro MONTUORI , Simone FAMULARO, Letizia SANTURRO, Giulia LO BIANCO, Alessandro GIANI, Fabio UGGERI, Luca V. GIANOTTI

Department of Surgery, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy

Acute appendicitis is commonly encountered in daily practice. The perforation of a retrocecal appendix can result in retroperitoneal abscess a condition that is still recognized as life-threatening. This emphasizes the importance of early diagnosis and prompt management for this uncommon complication. We present a case of unusual presentation of retroperitoneal abscess from perforated appendicitis and a review of the Literature. A 44-year-old woman arrived to our observation for the appearance by about 3 days of abdominal pain on the right quadrants irradiated to the lower limb. At the opening, we drained abscess cavity buffered on the caecum and its mesentery, which deepened in the back-peritoneum, affecting the ipsilateral ileo-psoas muscle and limbing the vertebral plane. Appendix stump was perforated. We performed appendectomy with multiple washings of the peritoneal cavity. The patient was discharged at 19th postoperative day. The development of a retroperitoneal abscess, however rare, remains one of the most serious complications of acute appendicitis and is always associated with the perforation of a retrocecal appendix. Its insidious onset may delay diagnosis and treatment making this clinical entity a challenge for the surgeon who will have to distinguish between primary and secondary psoas abscess when some combination symptoms such as fever, flank pain and limitation of hip movement arise. Acute perforated appendicitis can occasionally manifest as complicated retroperitoneal abscess. It has to be taken into account in the differential diagnosis of a primary psoas abscess. The surgeon’s experience is a key point in therapeutic strategy.

KEY WORDS: Retroperitoneal space; Abscess; Appendicitis

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