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Lecture 4 - 4th year mBBS SIMS
The document discusses various causes of intra-abdominal and retroperitoneal abscesses following surgery. It describes a case of a patient who underwent laparotomy for perforated duodenal perforation and subsequently developed fever and other symptoms. Possible causes discussed include plug leakage, abscess formation, or other sources of postoperative pyrexia. It then provides details on retroperitoneal abscesses, fibrosis, and tumors - outlining characteristics, causes, clinical features, and treatment considerations for each.
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Lecture 4 - 4th year mBBS SIMS
- 1. Lecture 4 Intraperitoneal Abscesses PelvicAbscess Retroperitoneal
- 2. Scenario • A 45year old Mrs. Nasir underwent laparotomy for the following investigation and peritonitis.
- 4. Scenario continued –4th post operative day • A 45 year old Mrs. Nasir underwent laparotomy for perforated duodenal perforation. Postoperatively she developed Fever, Malaise, lethargy, Anorexia and weight loss. Fever is of high grade and associated with Sweats ± rigors & chills.
- 5. What can gowrong ?
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- 7. Differential • Plug Leakage •Abscess formation • Any other cause of POP
- 8. 7W’s of postoperative pyrexia • Wind • Water • Wound • Walk • Wonder drugs • Weather • Waisay hee (idiopathic)
- 12. Scenario 2 • A45 year old Mr Nasir underwent laparotomy for perforated Appendix. Postoperatively he developed Fever, Malaise, lethargy, Anorexia and weight loss. Fever is of high grade and associated with Sweats ± rigors & chills. • On examination he complaints of Abdominal pain, diarrhoea and mucus discharge
- 13. What has Gonewrong ?
- 14. • Injury tothe Bowel • Leakage from the stump • Abscess formation • 7 W’s
- 20. THE RETROPERITONEAL SPACE •Retroperitoneal fibrosis • Retroperitoneal (psoas) abscess • Retroperitoneal tumours
- 21. Retroperitoneal fibrosis • Arare diagnosis - Flat grey/white plaque of tissue • Starts in the low lumbar region then spreads • Encase the common iliac vessels, ureters and aorta. • Histological appearances vary from active inflammation with a high cellular content interspersed with bundles of collagen through to one of acellularity and mature fibrosis/calcification. • Cause ??????
- 24. Retroperitoneal fibrosis -clinical features • Ill-defined chronic backache or • Compromise to involved structures, • e.g. lower limb or scrotal oedema or • chronic renal failure secondary to ureteric obstruction.
- 25. Retroperitoneal fibrosis -Management •Treatment will be directed to the cause & •Modification of disease activity when appropriate, e.g. •immunomodulation with steroids, •Tamoxifen and •Restoration of flow in affected structures, e.g. ureteric stenting.
- 26. Retroperitoneal (psoas) abscess •At the start of the twentieth century, psoas abscess was mainly caused by TB of the spine (Pott’s disease). • With the decline of M. tuberculosis as a major pathogen in resource- rich countries, • a psoas abscess was mostly found secondary to direct spread of infection from the inflamed ± perforated digestive or urinary tract. • In recent years a primary psoas abscess due to haematogenous spread from an occult source is more common, especially in immunocompromised and older patients, as well as in association with intravenous drug misuse.
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- 32. Retroperitoneal (psoas) abscess Clinicalpresentation • Back pain, lassitude and fever. • A swelling may point to the groin as it tracks along iliopsoas. • Pain may be elicited by passive extension of the hip • or a fixed flexion of the hip evident on inspection.
- 33. Retroperitoneal (psoas) abscess Clinicalpresentation .
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- 35. Retroperitoneal (psoas) abscess •At the start of the twentieth century, psoas abscess was mainly caused by TB of the spine (Pott’s disease). • With the decline of M. tuberculosis as a major pathogen in resource- rich countries, • Secondary to direct spread of infection from the inflamed ± perforated digestive or urinary tract. • Primary psoas abscess due to haematogenous spread from an occult source is more common, especially in immunocompromised and older patients, as well as in association with intravenous drug misuse.
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- 37. Retroperitoneal tumours • Directextension from surrounding Structures • Primary tumours of mesenchymal origin • Can be malignant ( Sarcomas) • Liposarcoma • Leimyosarcoma • Malignant fibrous histiocytoma (MFH)
Editor's Notes
- #10 Figure 61.7 (a) Intraperitoneal abscesses on transverse section: 1, the left subphrenic space; 2, left subhepatic space/lesser sac; 3, right subphrenic space; 4, right subhepatic space. (b) Intraperitoneal abscesses on sagittal section: 1, left subphrenic; 2, left subhepatic/ lesser sac; 3, right subphrenic; 4, right subhepatic.