A Case of Unresolved and Worsening Retroperitoneal Abscess

Retroperitoneal abscess is a rare condition which is difficult to diagnose and treat because of its insidious onset. Herein, we present a case of retroperitoneal abscess secondary to a perforation that occurred during an ERCP. A 54-year-old female patient was admitted to an outside hospital with gal...

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Bibliographic Details
Published in:Case reports in gastrointestinal medicine 2018-01, Vol.2018 (2018), p.1-5
Main Authors: Baum, Joel, Rosberger, Sonam, Chun, Soohwan, Barakat, Mohamed, Bansal, Raghav, Tiba, Melik
Format: Article
Language:English
Subjects:
Abdomen
Antibiotics
Bile
Case Report
Case reports
Cholecystectomy
CT imaging
Defects
Endoscopy
Gallstones
Hospitals
Laparoscopy
Medical imaging
Medical prognosis
Methylene blue
Pancreatitis
Tazobactam
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Summary:Retroperitoneal abscess is a rare condition which is difficult to diagnose and treat because of its insidious onset. Herein, we present a case of retroperitoneal abscess secondary to a perforation that occurred during an ERCP. A 54-year-old female patient was admitted to an outside hospital with gallstone pancreatitis and underwent ERCP with sphincterotomy followed by laparoscopic cholecystectomy. An abdominal CT scan was performed at the outside hospital 10 days later for worsening abdominal pain which showed multiple loculated pockets in the right upper and lower quadrant. Her condition improved after IV antibiotics and percutaneous drainage. Her symptoms recurred a month later and she presented to our hospital. Repeat abdominal CT scan at our hospital revealed recurrence of her abscesses. Multiple drains were placed and the abscess cavity was washed out without much improvement. EGD revealed a small mucosal defect in the distal portion of the duodenal bulb which was closed successfully using an over-the-scope clip. Repeat CT scan after 8 weeks from the endoscopic closure showed near complete resolution of the abscess. ERCP-associated perforation is a rare complication and can be challenging to diagnose and treat; prompt recognition is mandatory for favorable prognosis. Our patient was managed successfully via nonsurgical approach.
ISSN:2090-6528
2090-6536
DOI:10.1155/2018/6740734