Perinephric abscess as a rare cause of acute abdomen: A case report

Yıl 2020, , 102 - 104, 02.01.2020

Yilmaz Güler , Serkan Şengül Hasan Çalış Murat Uçar , Özkan Özen

https://doi.org/10.28982/josam.608975

Öz

Renal and perinephric abscesses are usually confined within the Gerota's fascia and treated with conservatively. We herein present a case with peritonitis caused by the spillage of perinephritic abscess into the abdomen through the Gerota’s fascia, which is clinical outcome. A 41-year-old female patient was admitted to emergency room with complaints of abdominal pain, bloating, fever, and fatigue. During the operation, an abscess of approximately 20x15cm in size was observed to extend into the abdominal cavity through the Gerota's fascia, causing secondary peritonitis. On the 20th postoperative day, the patient was uneventfully discharged. Delay in diagnosis of renal and perinephric abscesses can lead to fatal complications. Laparotomy is a life-saving approach in cases that cannot be treated with percutaneous drainage, when the abscess is large and causes complications such as strictures, fistulas, or secondary peritonitis, by extension through the Gerota's fascia, as in our case.

Anahtar Kelimeler

Perinephric abscess, Renal abscess, Secondary peritonitis, Acute abdomen

Akut batının nadir bir nedeni olarak perinefrik apse: Olgu sunumu

Öz

Renal ve perinefrik apseler genellikle Gerota fasyasında sınırlı kalırlar ve konservatif yöntemlerle tedavi edilirler. Bu çalışmada perinefritik apsenin nadir görülen klinik bir sonucu olarak Gerota fasyasından karın içerisine açılması sonucu sekonder peritonite sebep olduğu olguyu sunmayı amaçladık. 41 yaşında kadın hasta karın ağrısı, karında şişlik, ateş ve halsizlik şikayetleriyle hastanemiz acil servisine başvurdu. Acil opere edilen hastada Gerota fasyasından karın içine uzanan yaklaşık 20x15 cm çapında apse ve sekonder peritonit saptandı. Postoperatif 20. gün hasta şifa ile hastaneden taburcu edildi. Perinefritik apselerin tanısında gecikme olması öldürücü komplikasyonlara yol açabilir. Gerota fasyasını aşan, striktür, fistül veya bizim olgumuzda olduğu gibi sekonder peritonitin geliştiği ve perkütan drenajla tedavi edilemeyen geniş apselerde laparotomi hayat kurtarıcıdır.

Anahtar Kelimeler

Perinefrik apse, Renal apse, Sekonder peritonit, Akut karın

Kaynakça

• 1. Willard BT, Lynn J, Steinbecker K. Renal Corticomedullary Abscess. eMedicine. Eds. Jong M. Choe 27 Jul. 2004. Medscape. 13 Jan. 2005.
• 2. Lee SH, Jung HJ, Mah SY, Chung BH. Renal abscesses measuring 5 cm or less: outcome of medical treatment without therapeutic drainage. Yonsei Med J. 2010;(51)4:569-73.
• 3. Noble MJ. Perinephric abscess. AUA update Series. 2002;21(10):74-9.
• 4. Trusedale BH, Rous SN, Nelson RP. Perinephric abscess: A review of 26 cases. J Urol. 1977;118:910-1.
• 5. Sheinfeld J, Erturk E, Spataro RF, Cockett AT. Perinephric abscess: Current concepts. J Urol. 1987;137:191-4.
• 6. Sivarama Krishna G, Vijayalakshmidevi B, Lakshmi AY, Mutheswaraiah B, Sivakumar V. Perinephric abscess with extension into mediastinum and epidural space Indian Journal of Nephrology. 2012;22(3):225-7.
• 7. Asgin N, Satilmis S. Which antibiotics should we prefer empirical treatment of urinary tract infections in elderly patients? J Surg Med. 2019;3(12):856-60.
• 8. Varisli AN, Hazirolan GC, Celikbas AG, Aksoy A. Resistance patterns of gram negative bacteria in urinary tract infections and efficacy of empirical treatment in noncomplicated cases: Retrospective cohort study of 2180 women. J Surg Med. 2018;2(2):99-104.
• 9. Gardiner RA, Gwynne RA, Roberts SA. Perinephric abscess. Bju International. 2011;107(3):20-3.
• 10. Rubilotta E, Balzarro M, Lacola V, Sarti A, Porcaro AB, Artibani W. Current cilinical management of renal and perinephric abscesses. Urologia. 2014;81(3):144-7.
• 11. Sung BJ, Chung JM, Choi S, Rhew HY, Lee SD. Renal and perinephric abscesses: ten years experience at a single center. Korean J Urol. 2008;49(10):923-30.
• 12. Salvatierra O Jr, Bucklew WB, Morrow JW. Perinephric abscess: a report of 71 cases. J Urol. 1967;98(3):296-302.
• 13. Thorley JD, Jones SR, Sanford JP. Perinephric abscess. Medicine. 1974;53(6):441-51.
• 14. Dalla Palma L, Pozzi Mucelli F, Ene V. Medical treatment of renal and perirenal abscesses: CT evaluation. Clin. Radiol. 1999;54(12):792-7.
• 15. Hung CH, Liou JD, Yan MY, Chang CC. Immediate percutaneous drainage compared with surgical drainage of renal abscess. Int Urol Nephrol. 2007;39(1):51-5.
• 16. Siegel JF, Smith A, Moldwin R. Minimally invasive treatment of renal abscess. J Urol. 1996;155(1):52-5