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Clinical Observation |

Primary Retroperitoneal Abscess Extending to the Calf

Francesco Puccio, MD; Massimiliano Solazzo, MD; Stefano Chiodini, MD
Arch Surg. 2005;140(12):1230-1231. doi:10.1001/archsurg.140.12.1230.
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A 77-year-old man with diabetes mellitus presented with a 2-month history of lumbago radiating to the right lower limb as well as high fever spikes. Physical examination revealed a distended abdomen with right lower quadrant tenderness. A computed tomographic scan of the abdomen revealed a large right retroperitoneal cavity containing an air-fluid level that was consistent with a gas-producing abscess. The patient began receiving intravenous antibiotics, but fever and abdominal pain persisted and a large, fluctuating, tender swelling appeared on the medial aspect of his right thigh and right calf. The patient underwent surgical exploration: a right lateral abdominal incision was performed, and the pus collection in retroperitoneal space was completely evacuated. We also made 3 separate incisions on the medial aspect of the right thigh and 1 incision on the upper calf, resulting in the drainage of pus. The patient made a slow but steady recovery.

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Figure.

Patient’s computed tomographic scan showing the large right retroperitoneal cavity (arrow) containing an air-fluid level consistent with a gas-producing abscess (A), and his incisions on the medial aspect of the right thigh and an incision on the upper calf, resulting in the drainage of large amounts of pus (B).

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