Laparoscopic Drainage of a Kidney Abscess in a Difficult Location: A Case Report

Abstract

Introduction: We present a case of a kidney abscess of difficult localization and due to Proteus mirabilis. Presentation of the Case: It is a 29-year-old male patient with no pathological history who presented with left low back pain with intermittent feverish sensation 2 weeks before his admission. The physical examination noted left lumbar tenderness and a fever of 38.50C. The biological assessment noted hyperleukocytosis with polymorphonuclear neutrophils predominance and an elevation of C-reactive protein with infected urine. Initially objectified by ultrasound, an uro-computed tomography was performed and revealed an anterior superior polar abscess of the left kidney measuring 6cm in diameter. Faced with the impossibility of percutaneous radiological drainage, we resorted to laparoscopic drainage and continuation of antibiotic therapy with successful evolution. Discussion: Kidney abscesses are rare and sometimes with difficult location, which compromises the therapeutic approach. Their prevalence varies from 1 to 10 per 10,000 admissions with serious vital or functional complications. The most frequently found germs are Gram-negative bacilli. Ultrasound and especially CT scan make the diagnosis in 90% of cases and guide treatment. Antibiotic therapy alone or associated with percutaneous drainage depending on the abscess size constitutes the basis of treatment; surgical drainage is reserved for failure or impossibility of percutaneous drainage. Laparoscopy drainage constitutes an alternative of drainage in this situation. Conclusion: Kidney abscesses constitute a rare pathology but with consequences that can compromise the vital or functional prognosis of the kidney. Proteus mirabilis is a rare germ but commonly responsible for kidney abscesses. The clinic and methods of diagnosis of this abscess are identical to those due to other germs. Antibiotic therapy associated with imageguided percutaneous drainage was successful in the majority of cases. Drainage by laparoscopy is an alternative for draining abscesses in difficult locations when percutaneous drainage is impossible or fails.