A rare but dangerous disease, which is a complication of previous purulent-destructive diseases occurring in the abdominal and non-abdominal organs, is called retroperitoneal phlegmon. This disease makes the condition of the body more difficult and can lead to sepsis.
Causes of retroperitoneal phlegmon
Retroperitoneal phlegmon can occur with pancreatic necrosis or a purulent process in the kidneys, as well as in cases of other similar diseases. Usually, microbes are brought into the retroperitoneal space by the hematogenous or lymphogenous route, as well as through the gaps between the tissues during the operation.
But there are cases when the disease occurs much later after the surgery – after a few months or years. There are even cases of such phlegmon in people who have never been operated on in their lives, but who have undergone inflammation.
This disease is always secondary, in the diagnosis there is a connection with the foci of the primary infection. It can be any disease or inflammation of the abdominal or pelvic organs. In this case, it is possible for microflora to penetrate into the retroperitoneal tissue, which can cause suppuration – both hematogenously and lymphogenously. The most vulnerable are patients whose immunity is weakened, since the reduced defenses of the body in this case are unable to withstand the wide spread of pathogenic microbes, and therefore the separation of secondary foci of infection does not occur.
The most susceptible to the development of retroperitoneal phlegmon are equally men and women aged 25–42 years. The development of the process of formation of suppuration occurs to the same extent, often on both sides, in such areas of retroperitoneal tissue as the lumbar, including tissue, which is located above the iliac crest, along the outer border of the psoas muscle, directly in the perirenal region and next to the aorta, near the lower vena cava; iliac, including fiber, which is located in the region of the iliac fossa, along the outer border of the psoas muscle, along the iliac vessels; inguinal, including fiber directly above the base of the external vessels of the iliac region.
The symptomatology of retroperitoneal phlegmon is extremely nonspecific. At the very beginning of the disease, there is a high temperature up to 38 ° Celsius, chills and general malaise. Pain syndrome with its own characteristics manifests itself later. First, localization of pulling or throbbing pain occurs in the lumbar region. Then it spreads to other areas, as if spilling over considerable distances from the site of the focus of suppuration. This is due to the presence of a wide connection of retroperitoneal tissue with the central nervous system. Increased pain occurs with movement, in particular when walking, trying to sit or stand.
The rapid spread of retroperitoneal phlegmon can lead to the development of complications, including sepsis.
Treatment of retroperitoneal phlegmon
It is very difficult to diagnose retroperitoneal phlegmon, especially if we have a sluggish version of it with already prescribed measures for the treatment of an erroneous disease, for example, osteochondrosis of the spine. It is easier to diagnose acute phlegmons, they detect sharply painful infiltrates by palpation, the magnitude of which will depend on the location of suppuration. If the process develops in the iliac retroperitoneal tissue, then the infiltrate will be located in the region of the ilium of its anterior spine along the outer border of the spinal muscles. Examining the lumbar region, it will be possible to see the roundness of the silhouette of that part of the back where the development of the inflammatory process occurs. Often during palpation, tension can be observed both in the dorsal and abdominal muscles. During the examination, you can see the curvature of the lower back in the region of the spine, while deviations will be recorded towards the healthy part. But when diagnosing retroperitoneal phlegmon, due to the fact that suppuration is located deep, it is very difficult to determine changes and fluctuations.
Laboratory tests are also of little help in diagnosis, since they usually indicate only the presence of the inflammatory process itself, without indicating the location. Blood tests show a pronounced leukocytosis with the observation of a shift of the leukocyte formula to the left and an increased ESR.
Treatment of retroperitoneal phlegmon begins to be carried out in a conservative way, but they should not be limited in the case when there is no improvement in the patient’s condition even after two days from the moment of hospitalization. Despite the fact that antibiotic therapy is currently achieving some success in the treatment of purulent diseases and related complications, it often happens that the only effective measure that can cure retroperitoneal phlegmon is surgery. This operation is performed under general anesthesia. Its purpose is to open suppuration, drain the wound in order to conduct active aspiration. The postoperative period of treatment is characterized by a set of measures that are aimed at treating the main disease and preventing the recurrence of phlegmon. This is antibiotic therapy and general strengthening. Detoxification therapy is also carried out by blood transfusion, protein substitutes, plasma, infusions of glucose-salt solutions, electrolytes, etc.