Abscesses developing within the retroperitoneal space are serious surgical infections which are associated with prolonged morbidity and high mortality unless diagnosed early and treated adequately. Two cases encountered recently in our clinic are reported, and the records of 39 patients with proven abscess of the retroperitoneal space seen in Japan during the period between 1959 and 1983 have been reviewed.
Case 1. A 36-year-old man had undergone cholecystectomy and papilloplasty for acute cholecystitis and cholecysto-choledocho-lithiasis. At the fourth day after surgery, dark reddish dirty discharge spewed out from the right flank drain. The patient underwent surgical exploration and a diffuse retroperitoneal phlegmon was drained after the 12th day. Culture of the pus was positive for Enterobacter, Klebsiella, etc. He did not do well and died at the 60th postoperative day.
Case 2. A 54-year-old man was operated upon for retroperitoneal hematoma due to rupture of an anterior superior pancreaticoduodenal arterial aneurysm. At the fifth day after the operation, dirty pus was noticed in the drain. Culture of the pus grew Streptococcus faecalis, Bacteroides fragilis, etc. He was treated with numerous drugs, but he died 46 days postoperatively.
The age range in the Japanese series was from newborn to 78 years. In this group, the causes and anatomical locations of infection were renoureteral in seven, gastrointestinal in eight, tuberculosis in ten, and postoperative in six. Of all, five cases were diagnosed at autopsy, 26 cases operated upon and one of them died;however, of nine nonoperative patients, six died. It seems that early diagnosis and adequate therapy may diminish mobidity and mortality.