Retroperitoneal Abscess
Basics
Description
- A collection of purulent fluid located in the space between the peritoneum and transversalis fascia lining the posterior abdominal cavity
- Classified as primary if spread hematogenously or secondary if spread through infection of an adjacent organ
- The retroperitoneum can be further subdivided into three compartments:
- Anterior pararenal space
- 2nd and 3rd segments of the duodenum, pancreas, bile duct, portal and splenic veins, appendix, ascending/descending colon, transverse mesocolon
- Perirenal space
- Kidneys, renal vessels, adrenal glands
- Posterior pararenal space
- Contains no major organs and is filled with fat, blood vessels, and lymphatics
- Bounded by renal fascia and the muscles of the posterior abdominal wall
- Anterior pararenal space
Epidemiology
Incidence
Prevalence
Rare condition in which perirenal abscesses are more common (2)
Etiology and Pathophysiology
- Bowel perforation secondary to neoplastic disease, diverticulitis, pancreatitis, pancreatic cancer, retroperitoneal appendicitis, biliary tract disease, peptic ulcer disease, inflammatory bowel disease, peritonitis, colonoscopy following GI surgery, bowel infarction (1)
- Genitourinary (GU) extravasation secondary to obstruction, nephrolithiasis, pyelonephritis, urinary tract infection, urologic surgery, pelvic surgery, ovarian cancer
- Osteomyelitis of vertebral bodies or 12th rib, epidural abscess (1)
- Less common causes are trauma, hematogenous or lymphatic seeding from a distant infection, or postoperative complication (1).
- Infection seeds a confined space within the retroperitoneum.
- Can be a monomorphic or polymorphic predominance of organisms
- Typically consists of normal flora from adjacent organs (i.e., GI, GU, and female reproductive tract)
- Hypoxia and lack of appropriate blood supply limit effective immune response.
- Osmotic forces produce growth of abscess cavity.
- Mycobacterium tuberculosis was previously a common pathogen but is less common today.
- Most common pathogens
- Staphylococcus aureus
- Streptococcus sp.
- Enterobacteriaceae
- Citrobacter sp.
- Escherichia coli
- Klebsiella
- Proteus sp.
- Pseudomonas aeruginosa
- Serratia
- Anaerobes
- Actinomyces
- Peptostreptococcus
- Bacteroides fragilis
- Prevotella sp.
- Clostridium sp.
- Enterococcus sp.
- Tuberculosis sp.
- Fungus
- Candida sp.
Pediatric Considerations
Consider necrotizing enterocolitis as an etiology in newborns.
Risk Factors
- Appendicitis
- Bowel perforation
- Chronic urinary retention
- Diabetes
- Diverticulitis
- Epidural infection
- GU tract obstruction
- Immunosuppression
- Inflammatory bowel disease
- Malignancy of the GU, GI, or female reproductive tract
- Osteomyelitis of the spine or ribs
- Pancreatitis
- Pelvic inflammatory disease
- Pregnancy
- Pyelonephritis
- Recent surgery of GU or GI
- Renal biopsy
- Tuberculosis (TB)
General Prevention
- Treatment of the primary disease
- Prevention of infection, such as perioperative antibiotic prophylaxis
- Prompt treatment of symptomatic infection
Commonly Associated Conditions
- Bowel perforation
- Diabetes mellitus
- Diverticulitis
- Immunosuppression (HIV, glucocorticoid use)
- Inflammatory bowel disease
- Malignancy (GI or GU)
- Nephrolithiasis
- Osteomyelitis of the spine or ribs
- Pelvic inflammatory disease
- Renal insufficiency
- Retroperitoneal hematoma
- Surgery (GI or GU)
- Urinary tract infections
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Citation
Domino, Frank J., et al., editors. "Retroperitoneal Abscess." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816864/all/Retroperitoneal_Abscess.
Retroperitoneal Abscess. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816864/all/Retroperitoneal_Abscess. Accessed December 11, 2024.
Retroperitoneal Abscess. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816864/all/Retroperitoneal_Abscess
Retroperitoneal Abscess [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 December 11]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816864/all/Retroperitoneal_Abscess.
* Article titles in AMA citation format should be in sentence-case
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T1 - Retroperitoneal Abscess
ID - 816864
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ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816864/all/Retroperitoneal_Abscess
PB - Wolters Kluwer
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DB - Medicine Central
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