Images in Clinical

A Giant Retroperitoneal Abscess Mimicking Incarcerated Inguinal Hernia

10.4274/jus.2014.187

  • Naciye Sinem Gezer
  • Nuri Karabay
  • Özkan Alatas
  • Ali Çaylak
  • Abdullah Taylan
  • Koray Atila

Received Date: 05.11.2014 Accepted Date: 11.11.2014 J Urol Surg 2015;2(2):118-119

Introduction

An 82-year-old man was admitted to the emergency room with an acute left-sided groin pain and scrotal swelling. He has suffered from a groin hernia for two years. Abdominal x-ray demonstrated air-fluid levels in the left upper quadrant suggesting an intestinal obstruction (Figure 1). Abdominal computed tomography (CT) scan was obtained with an initial diagnosis of an incarcerated inguinal hernia. However, it showed multiple perirenal abscesses and a giant-sized retroperitoneal abscess extending from the retroperitoneal space into the scrotum through the inguinal canal (Figure 2 and 3). Retroperitoneal abscesses are most frequently seen in the 3rd to 6th decades of life (1). Gram-negative bacteria, most commonly E. coli, are the cause of infection which usually develops secondary to pyelonephritis, urinary stasis or immune suppression. The onset of clinical manifestations of the infection, including flank, abdomen and groin pain, chills, fever, tachycardia, weakness and anorexia are often insidious (2,3). Laboratory findings include leukocytosis, increased serum creatinine levels and pyuria. The literature emphasizes the possibility of diagnostic delay and postponed treatment of retroperitoneal abscess due to the fact that its prodrome phase may be long. In order to reduce the morbidity and mortality, it is important to consider retroperitoneal abscess in the differential diagnosis and consult radiological examinations without any delay. CT is superior to other methods in the diagnosis and the planning of treatment. It is the most valuable imaging modality to demonstrate anatomical localization and size of the abscess (4). Direct radiography findings, including abnormal psoas shadow and renal contour, scoliosis, air-fluid levels, ipsilateral hemidiaphragm elevation, basal atelectasis and pleural effusion can be detected in 38-90% of patients (4). Ultrasonography can be used to follow up the treatment response. The present case is remarkable in terms of demonstrating that a delayed diagnosis and postponed treatment of a retroperitoneal abscess may lead to spread of the infectious process that may even extend from retroperitoneal space into the scrotum through the inguinal canal and mimic an indirect inguinal hernia. Concept: Naciye Sinem Gezer Design: Naciye Sinem Gezer Data Collection or Processing: Naciye Sinem Gezer, Özkan Alatas, Ali Çaylak, Abdullah Taylan Analysis or Interpretation: Nuri Karabay, Koray Atila Literature Search: Özkan Alatas, Ali Çaylak, Abdullah Taylan Writing: Naciye Sinem Gezer Peer-review: Internal peer-reviewed. Conflict of Interest: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study has received no financial support.


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