An unusual case of a retroperitoneal abscess

Abstract

Retroperitoneal abscesses are unusual occurrences which pose significant diagnostic and clinical challenges. The presentation can be insidious and occult in nature with a distinct lack of abdominal signs. There is often a delay in diagnosis, and inadequate drainage, leading to high mortality rates. We report a case of thigh emphysema originating from a retroperitoneal abscess. The patient was an 88-year-old diabetic woman who complained of a vague 4-week history of left thigh pain and an inability to fully weight-bear. She presented to our Emergency Department with sepsis and acute renal failure. An initial X-ray of her left thigh revealed extensive gas distribution throughout the soft tissues. A retroperitoneal abscess involving the left renal fossa, psoas, iliacus, and upper thigh muscles was later diagnosed on CT. We will present the anatomy of the retroperitoneum and the structures and organs within. Included in our presentation will be how abscesses in the retroperitoneum spread and infiltrate into adjacent anatomical structures.