Management and outcome of retroperitoneal abscesses

Retroperitoneal space abscesses are unusual clinical problems encountered by general surgeons, internists, and surgical subspecialists. An insidious, occult illness marked by diagnostic delay, inadequate drainage, and considerable morbidity and mortality is common. Anatomic reviews detailing the complex extraperitoneal spaces have been published, but less attention has been focused on diagnostic and drainage techniques useful to the practicing surgeon. In a retrospective review of 50 extraperitoneal abscesses, attention was directed to clinical presentation, diagnosis, and therapy. On the average, 12.7 days were required to establish the diagnosis; 50% of patients suffered major complications. A strikingly high mortality was associated with positive blood cultures and persistent fever within 48 hours of drainage (75% and 71%, respectively). Computed tomography has greatly enhanced the diagnosis of extraperitoneal abscesses, and radiologic drainage in selected cases appears to be a useful initial approach. A simplified anatomic classification and treatment plan is proposed to facilitate comparison between clinical series.