Perinephric Abscess Research Articles

Perinephric Abscess Radiologically Mimicking Dilated Bowel

<h3>History</h3> A 45-year-old diabetic woman had the acute onset of fever, chills, nausea, vomiting, right flank pain, and dysuria. She was admitted to the referring hospital with diagnoses of poorly controlled diabetes mellitus and gram-negative shock. She was resuscitated with intravenous (IV) fluids, a continuous insulin infusion (insulin zinc suspension), and parenteral antibiotics. A right pleural effusion subsequently developed, and multiple thoracenteses were nondiagnostic. The right kidney could not be visualized in an IV pyelogram. She was transferred to the University of New Mexico Hospital because of persistent fever after two weeks of antibiotic therapy. A plain film of the abdomen demonstrated a localized collection of gas, with an air-fluid level in the upper right quadrant suggesting dilation of the hepatic flexure of the colon or a dilated loop of small bowel (Fig 1). No calcifications were detected. Shortly after admission, a right retrograde pyelogram showed a distorted collecting system,

Perinephric abscess radiologically mimicking dilated bowel

Perinephric abscess radiologically mimicking dilated bowel

Radiological diagnosis of perinephric abscess

Radiological diagnosis of perinephric abscess

Renal tumor infarction with absolute ethanol.

Sixteen renal tumors were infarcted with intraarterial absolute ethanol. Renal tumor infarction was performed for one of three indications: for palliation of symptoms in patients with metastatic disease, as a preoperative measure to reduce blood loss during radical nephrectomy, or as a primary therapy in selected circumstances. In most cases, absolute ethanol was injected into the main renal artery through a balloon occlusion catheter. In all cases, ethanol produced effective infarction of the renal tumor. Only one complication developed, a perinephric abscess that developed several weeks after the infarction. Results indicate that absolute ethanol is a safe and effective agent for the infarction of renal tumors.

Staghorn Calculus: Its Clinical Presentation, Complications and Management

AbstractThere were 95 patients (105 kidneys) with staghorn calculi evaluated clinically and 84 kidneys were studied on a pathologic basis. Only 1 per cent of the patients could be defined as having a silent stone calculus. Clinical complications occurred in 53 per cent of the patients. Of 84 kidneys submitted for a pathoanatomic study (surgical evaluation and/or histopathology) pyonephrosis was found in 20 per cent, xanthogranulomatous pyelonephritis in 8 per cent, end stage pyelonephritic kidney in 6 per cent, end stage hydronephrotic kidney in 7 per cent, severe pyelonephritic changes in 7 per cent and a perinephric abscess in 5 per cent. The kidney was considered to be relatively undamaged in 51 per cent of the cases. Complete removal of the calculus and appropriate medical adjunctive therapy should be done early in the course of the disease in an attempt to prevent complications and renal deterioration. The results of treatment are discussed and compared to those obtained in a group of patients who initially were managed conservatively.

Successful Percutaneous Management of Renal Abscess

Six patients with intrarenal and perinephric abscesses underwent successful nonoperative management by percutaneous aspiration and systemic antibiotic therapy. The concept of percutaneous management is discussed with reference to its benefits, risks and technical variations.

Perinephric abscess secondary to ruptured retrocecal appendix diagnosed by computerized tomography

A case of a perinephric abscess secondary to a ruptured retroappendiceal appendix was diagnosed preoperatively by computerized tomography of the abdomen. The radiologic anatomy of the retroperitoneum is reviewed along with a discussion of the origin of perinephric abscesses and the complication of acute appendicitis.

Percutaneous drainage of renal and perinephric abscess.

Computed tomography and ultrasonography are effective methods for diagnosis and localization of renal and perinephric abscesses. In patients with clinical suspicion of sepsis, diagnostic needle aspiration of these lesions can be safely performed extraperitoneally by using sectional imaging for guidance. When an abscess is confirmed, small catheters can be introduced percutaneously via the diagnostic aspiration route to provide immediate decompression as well as continuous and definitive drainage without need for surgery. In 8 cases so treated, there were no major complications, deaths, or recurrences. These results, obtainable without the risks of surgery, indicate that patients with renal or perinephric abscesses should be offered a trial of percutaneous drainage as a definitive method of therapy. Those cases not amenable to percutaneous drainage, or those in which the procedure has failed, can then be drained surgically. Percutaneous abscess drainage is widely applicable because it can be performed in any uroradiologic facility with access to sectional imaging.

Nephrobronchial fistula: Complication of perinephric abscess secondary to ureteral obstruction and pyonephrosis

A case of nephrolithiasis complicated by obstruction leading to pyonephrosis, perinephric abscess, and nephrobronchial fistula is presented. The patient was treated successfully by nephrectomy and drainage of the subphrenic space and the pleural cavity. Nephrobroncial fistula, while a rare complication of perinephric abscess, should be considered when a patient presents with perirenal suppurative process and chest x-ray findings consistent with pleural effusion or pulmonary infiltrates.

Anaerobic Bacteria in Suppurative Infections of the Male Genitourinary System

Cultures were done to determine the prevalence of anaerobic bacteria in 18 male patients with suppurative infections of the genitourinary tract. The types of infections studied were scrotal abscess, prostatic abscess, scrotal gangrene and perinephric abscess. Anaerobic bacteria were recovered in 16 of the 18 specimens examined. These 16 specimens yielded a total of 48 anaerobic strains and 19 aerobic or facultative strains. The dominant organism isolated was Bacteroides fragilis, which was found in 11 patients. It would appear that most suppurative infections of the male genitourinary tract involve anaerobic bacteria. These observations have important implications regarding recommendations for cultures and selection of antimicrobials.

Xanthogranulomatous pyelonephritis.

Thirty-eight nephrectomy specimens and two biopsies of perinephric abscesses from patients with xanthogranulomatous pyelonephritis have been examined. Twenty showed evidence of venous damage. This included organised thrombi in 12, intimal thickening in five and phlebitis in three. All specimens showed evidence of previous haemorrhage in the form of haemosiderin deposition. These findings differed significantly from a control series of chronic pyelonephritis. It is suggested that venous occlusion and haemorrhage are factors in the pathogenesis of the lipid accumulation in the kidney which is characteristic of this condition. The association of a papillary transitional cell carcinoma of the pelvis in a patient with xanthogranulomatous pyelonephritis is reported for the first time.

Nephrobronchial fistula Complication of perinephric abscess secondary to ureteral obstruction and pyonephrosis

A case of nephrolithiasis complicated by obstruction leading to pyonephrosis, perinephric abscess, and nephrobronchial fistula is presented. The patient was treated successfully by nephrectomy and drainage of the subphrenic space and the pleural cavity. Nephrobronchial fistula, while a rare complication of perinephric abscess, should be considered when a patient presents with perirenal suppurative process and chest x-ray findings consistent with pleural effusion or pulmonary infiltrates.

Analysis of 607 cases of choledochal sphincterotomy.

AbstractThis is a report of the morbidity and mortality rates in 607 patients who underwent sphincterotomy (SPH), 324 of whom were more than 60 years of age. During the operation there were technical errors in 6 cases; a false passage was made in 5 (and recognized in 4); and the duodenal wall was lacerated and repaired in 1. Postoperative morbidity developed in 43 patients (7.1%) and included general disorders in 16 (2.6%), operative complications unrelated to SPH in 12 (2.0%), and complications due to SPH in the remaining 15 (2.5%). The SPH‐related complications included hemobilia (5 cases), subphrenic or perinephric abscess (4 cases), and biliary or jejunal fistula (3 cases). Postoperative mortality rate was 3.1% (19 cases). Eight of these deaths (1.3%) were due to abdominal complications which included acute pancreatitis (4), hemobilia (2), biliary fistula (2), and duodenal fistula (1). Of 544 patients reviewed after more than 1 year, there were only 12 failures (2.2%) and 23 minor sequelae. It is concluded that sphincterotomy, if correctly performed, is associated with low morbidity and mortality rates, and excellent long‐term results in 94% of patients.

Double-tracer, multiple-organ transaxial emission computed tomography: improved localization and characterization of radiotracer distributions.

Transaxial emission computed tomography (ECT) was performed in dogs with experimentally induced abscesses, using 67Ga and several 99mTc-labeled organ-specific radiopharmaceuticals. Superimposition of 99mTc ECT images onto the 67Ga images gave the precise anatomic location of the abnormal foci of 67Ga uptake, correctly localizing a perinephric abscess, a splenic abscess, and a focus of osteomyelitis. This technique also permits further characterization of regions of decreased activity.

Infection and diabetes mellitus.

Most physicians believe that diabetic individuals are predisposed to infections and that infection complicates the control of the diabetes. However, only bacteriuria can be documented to occur with increased frequency in diabetic compared with nondiabetic patients. Although most bacteriuric diabetic patients are asymptomatic, severe infections such as emphysematous pyelonephritis, papillary necrosis, perinephric abscess, and candida pyelonephritis may occur. Tuberculosis, once a proven threat to diabetic individuals, is a less serious problem now that effective screening and chemoprophylaxis programs have been initiated. Several unusual infections such as malignant external otitis, rhinocerebral mucormycosis, emphysematous pyelonephritis, and emphysematous cholecystitis occur also exclusively in diabetics. Foot infections are very important in diabetic patients; successful treatment requires accurate assessment of the extent and etiology of the infections and often involves surgery as well as broad antibiotic coverage. The important problem of infection in diabetic patients deserves careful evaluation. Questions such as do diabetic individuals have a higher incidence of infection, why are diabetic patients predisposed to infection, why is necrosis common in several of the infections, what is the course of asymptomatic bacteriuria, who do diabetic patients develop foot infections, and how should foot infections be prevented and treated should be topics of clinical investigation.

Bilateral Endophthalmitis in Acute Bacterial Endocarditis

A 53-year-old diabetic woman had ketoacidosis, urinary tract infection, and bilateral endophthalmitis. She subsequently developed a ruptured chorda tendineae of the mitral valve, and a diagnosis of acute bacterial endocarditis was made. No organisms were cultured during life or at autopsy. At autopsy, bilateral nongranulomatous panophthalmitis was found with perinephric, myocardial, intracranial, and mitral valve abscesses.

The Role of Computed Tomography in the Diagnosis of Renal and Perirenal Abscesses

Computed tomography was done on 4 patients suspected of having an intrarenal or perirenal abscess based on clinical grounds and an abnormal excretory urogram. Intrarenal abscesses with perinephric extension were demonstrated in 3 patients and a solitary perinephric abscess was demonstrated in 1. Computed tomography is a valuable tool in the diagnostic study of suspected intrarenal and perirenal abscesses because not only can the primary abscess be shown but also its possible extrarenal extension.

Spontaneous extravasation of urine in chronic ureteric obstruction

Two cases of spontaneous extravasation of urine in chronic ureteric obstruction are presented. In 1 case the long-standing partial ureteric obstruction was caused by enlarged lymphomatous glands, and extravasation was followed by a perinephric abscess. In the second case, believed to be unique, there was a moderate chronic ureteric obstruction post irradiation, and extravasation was induced by a sudden rise in intra-abdominal pressure due to vomiting.

Fatal retroperitoneal hemorrhage. An unusual complication of renal cortical abscess

RENAL cortical abscess (renal carbuncle) is an uncommon disorder that may be associated with a variety of clinical and pathological complications. These have included perforation (with or without fistula formation) into contiguous areas such as the peritoneal cavity, perinephric space, and renal pelvis.1Peritonitis, perinephric abscess, and urinary tract infection or obstruction may follow. Chronic renal cortical abscess may also closely mimic renal neoplasms and occasionally be responsible for prolonged fever of unknown origin. Recently, we cared for a patient with a renal cortical abscess in whom a massive retroperitoneal hemorrhage developed. Bleeding appeared to result from abscess erosion into the renal vasculature. This case illustrates an unusual and catastrophic complication of a visceral abscess. Report of a Case A 42-year-old alcoholic woman was hospitalized because of one day of severe right upper quadrant pain and abrupt abdominal distension. She was acutely ill and tachypneic. The blood pressure was

Fatal Retroperitoneal Hemorrhage

RENAL cortical abscess (renal carbuncle) is an uncommon disorder that may be associated with a variety of clinical and pathological complications. These have included perforation (with or without fistula formation) into contiguous areas such as the peritoneal cavity, perinephric space, and renal pelvis.1Peritonitis, perinephric abscess, and urinary tract infection or obstruction may follow. Chronic renal cortical abscess may also closely mimic renal neoplasms and occasionally be responsible for prolonged fever of unknown origin. Recently, we cared for a patient with a renal cortical abscess in whom a massive retroperitoneal hemorrhage developed. Bleeding appeared to result from abscess erosion into the renal vasculature. This case illustrates an unusual and catastrophic complication of a visceral abscess. Report of a Case A 42-year-old alcoholic woman was hospitalized because of one day of severe right upper quadrant pain and abrupt abdominal distension. She was acutely ill and tachypneic. The blood pressure was