| Summary: | An 82-year-old man was admitted to the emergency room with an
acute left-sided groin pain and scrotal swelling. He has suffered
from a groin hernia for two years. Abdominal x-ray demonstrated
air-fluid levels in the left upper quadrant suggesting an intestinal
obstruction (Figure 1). Abdominal computed tomography (CT)
scan was obtained with an initial diagnosis of an incarcerated
inguinal hernia. However, it showed multiple perirenal abscesses
and a giant-sized retroperitoneal abscess extending from the
retroperitoneal space into the scrotum through the inguinal canal
(Figure 2 and 3).
Retroperitoneal abscesses are most frequently seen in the 3rd to
6th decades of life (1). Gram-negative bacteria, most commonly E.
coli, are the cause of infection which usually develops secondary to
pyelonephritis, urinary stasis or immune suppression. The onset of
clinical manifestations of the infection, including flank, abdomen
and groin pain, chills, fever, tachycardia, weakness and anorexia
are often insidious (2,3). Laboratory findings include leukocytosis,
increased serum creatinine levels and pyuria. The literature
emphasizes the possibility of diagnostic delay and postponed
treatment of retroperitoneal abscess due to the fact that its
prodrome phase may be long.
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