RETROPERITONEAL ABSCESS DUE TO PERFORATED DIVERTICULITIS- CASE

PRESENTATION

T. Ptracu, O. Mihalache, H. Doran, E. Catrina, F. Bobirc, D. Georgescu

Surgical Clinic I.Juvara, Clinical Hospital Dr. I. Cantacuzino Bucharest

Diverticular disease includes a spectrum of conditions ranging from asymptomatic

diverticular disease, to symptomatic uncomplicated diverticular disease, to and complicated

diverticular disease that includes acute and chronic diverticulitis. While most people with

diverticular disease remain asymptomatic, between 10% and 25% develop symptoms, and of

these 15% will develop significant complications. Perforated colonic diverticular disease

results in considerable mortality and morbidity

We present the case of a 61 year old patient admitted in our clinic for abdominal pain, fever

and absence of intestinal transit. Clinical examination reveal pain and a tender mass in the left

iliac fossa without signs of peritonitis. The white blood cell count showed high leukocytosis,

abdominal x-Ray examination revealed air along the left psoas muscle. Diagnosis was

confirmed by the abdominal CT - retroperitoneal abscess with air retroperitoneally.

Emergency surgical intervention was performed, we chose a retroperitoneal approach for the

drainage of the retroperitoneal abscess and also a terminal colostomy on the transverse colon

was made. Postoperatory evolution was without complication the patient was discharged 30

days after the surgical procedure. 3 and 6 months follow-up still showed inflammation and the

presence of a colonic fistula, and the curative intervention cannot be finalized due to an strong

process of plastic peritonitis which occupied the entire peritoneal cavity.

Although rare, retroperitoneal perforation of an inflamed divertculum may represent the first

symptom of the diverticular disease. The severity of this complication is augmented by the

difficulty of an early diagnosis which can delay the surgical intervention