A Case of Unresolved and Worsening Retroperitoneal Abscess

Abstract

Retroperitoneal abscess is a rare condition which is difficult to diagnose and treat because of its insidious onset. Herein, we present a case of retroperitoneal abscess secondary to a perforation that occurred during an ERCP. A 54-year-old female patient was admitted to an outside hospital with gallstone pancreatitis and underwent ERCP with sphincterotomy followed by laparoscopic cholecystectomy. An abdominal CT scan was performed at the outside hospital 10 days later for worsening abdominal pain which showed multiple loculated pockets in the right upper and lower quadrant. Her condition improved after IV antibiotics and percutaneous drainage. Her symptoms recurred a month later and she presented to our hospital. Repeat abdominal CT scan at our hospital revealed recurrence of her abscesses. Multiple drains were placed and the abscess cavity was washed out without much improvement. EGD revealed a small mucosal defect in the distal portion of the duodenal bulb which was closed successfully using an over-the-scope clip. Repeat CT scan after 8 weeks from the endoscopic closure showed near complete resolution of the abscess. ERCP-associated perforation is a rare complication and can be challenging to diagnose and treat; prompt recognition is mandatory for favorable prognosis. Our patient was managed successfully via nonsurgical approach.

Endoscopic Retrograde Cholangiopancreatography Leading to Pharyngeal Perforation

“…When perforations do occur, they result in infection with anaerobic and aerobic microbes which inhabit the oropharynx via local translocation. Commonly seen organisms in such cases include H. parainfluenza, which is known to inhabit the oral cavity [17,18], and alpha hemolytic streptococci (S. mitis), known to inhabit the upper gastrointestinal tract [19].…”

“…In conclusion, perforations and abscess formation after ERCP have been reported in <1% of cases. When they do occur, they most commonly occur below the oropharynx and are colonized by gastrointestinal and respiratory tract flora [17][18][19]. Because of the intrinsic weakness in the pharyngeal musculature, shearing stress from advancement of an endoscope can lead to perforation.…”

Inguinal and Perineal Necrotizing Fasciitis, A Rare Clinical Manifestation of Necrotizing Pancreatitis: Two Case Reports

“…Retroperitoneal abscess is a rare clinical presentation and that is difficult to diagnose. It can result from various causes, such as pancreatitis, appendicitis, diverticulitis, trauma, malignancy, inflammatory bowel disease, pyelonephritis, spinal infection, peptic ulcer disease, and instrumentation [1]. Acute pancreatitis is a common gastrointestinal disorder [2].…”