腎臟鏡輔助下施行復發性巨大後腹腔膿瘍引流手術
郭謹瑋、張建祥、黃勝賢、陳俊吉
彰化基督教醫院 外科部 泌尿科
Nepheroscope-assisted drainage of a massive recurrent retroperitoneal abscess
Kuo-Chin Wei, Jian-Xiang Zhang, Sheng-Hsien Huang, Chun-Chi Chen
Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
Introduction:
Retroperitoneal abscess is a kind of complicated disease, it can caused by renal stone, necrotizing fasciitis, appendicitis or even duodenal ulcer. Adequate drainage and coverage of appropriate antibiotics is necessary to treat retroperitoneal abscess. We demonstrate a special technique that use nephroscope as our instrument to drain a recurrent massive retroperitoneal abscess.
Case report:
A 57 years old female, who had the history of right retroperitoneal abscess, s/p subcostal incision and drainage of abscess, complained about right flank pain for one week accompanied with mild fever. Lab data showed leukocytosis, KUB revealed lots air accumulation of right abdomen. Echo showed massive fluid accumulation over right para-renal space, about 19cm* 10cm in size. Under the impression of recurrent retroperitoneal abscess, we prescribed echo-guide nephroscope-assisted drainage of retroperitoneal abscess. After operation, there was just only one 2cm wound. And drainage tube was inserted thru the wound to retroperitoneal space. After operation, her condition was quite stable, no spiking fever or septic shock was noted. And she was discharged after two weeks antibiotics treatment.
Discussion:
The gold standard treatment of retroperitoneal abscess is adequate drainage. CT-guide or echo-guide drainage with pig-tail insertion may be the first choice. However, in some big abscess, pig-tail drainage is not enough and operation may be needed. The traditional way of retroperitoneal abscess drainage is subcostal retroperitoneal approach. And some people have demonstrated laparoscope-assisted drainage of retroperitoneal abscess. However there are some disadvantage such as wound pain and the concern of elevated retroperitoneal pressure associated sepsis. We described a special technique to create a small wound and under nephroscope guide, you can suction, irrigation, remove necrotic tissues or even insert adequate drainage tube.
Conclusion:
Nephroscope-assisted drainage of retroperitoneal abscess is an ideal way to treat retroperitoneal abscess.