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Diagnostik und Therapie retroperitonealer Abszesse

Diagnosis and treatment of retroperitoneal abscesses

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Zusammenfassung

Hintergrund

Retroperitoneale Abszesse stellen ein seltenes und lebensbedrohliches Krankheitsbild dar. Je nach Lokalisation und Ausdehnung unterscheidet man zwischen renalen, perinephritischen und paranephritischen Abszessen. Häufigste Ursache sind aufsteigende urogenitale Infektionen mit gramnegativen Erregern.

Symptomatik

Die Symptomatik ist sehr variabel was oftmals zu einer verzögerten Diagnosestellung führt; dies bedingt eine hohe Morbidität und Mortalität. Typische Symptome sind Flanken- oder Bauchschmerzen, Appetitlosigkeit, Gewichtsverlust, Krankheitsgefühl, Fieber und Schüttelfrost. Paraklinisch kommt es zu einem Anstieg der Leukozyten und des C‑reaktiven Proteins, auch die Retentionsparameter können erhöht sein.

Schlussfolgerung

Bei klinischem Verdacht führt die Sonographie meist zu einer weitergehenden bildgebenden Diagnostik mittels Computertomographie. Kleine intrarenale Abszesse bis zu einer Größe von 3 cm können durch alleinige Antibiotikatherapie behandelt werden. Größere und therapierefraktäre Abszesse sollten darüber hinaus perkutan oder chirurgisch drainiert werden.

Abstract

Background

Retroperitoneal abscesses are rare but life threatening. Renal, perinephritic, and paranephritic abscesses are distinguished depending on their location and extent. They are mainly caused by ascending urologic infections of gram-negative bacteria.

Symptomatology

The variable symptomatology often leads to delayed diagnosis resulting in high morbidity and mortality. Typical symptoms are flank or abdominal pain, decreased appetite, weight loss, malaise, fever, and chills. Laboratory values show increased leukocytes and C‑reactive protein. Creatinine levels may also be increased.

Conclusion

If there is clinical evidence for a retroperitoneal abscess, sonography generally leads to further diagnostic via computed tomography. Small abscesses may be treated by antibiotics alone. Abscesses larger than 3 cm and those not responding to medical treatment should be percutaneously or surgically drained.

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Authors and Affiliations

  1. Urologische Klinik und Poliklinik, Universitätsklinikum Jena, Lessingstraße 1, 07743, Jena, Deutschland

    B. M. Winter & M.-O. Grimm

  2. Institut für Pathologie, Universitätsklinikum Jena, Ziegelmühlenweg 1, 07743, Jena, Deutschland

    M. Gajda

Authors
  1. B. M. Winter
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  2. M. Gajda
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  3. M.-O. Grimm
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Correspondence to B. M. Winter.

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B. Winter, M. Gajda und M.-O. Grimm geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Winter, B., Gajda, M. & Grimm, MO. Diagnostik und Therapie retroperitonealer Abszesse. Urologe 55, 741–747 (2016). https://doi.org/10.1007/s00120-016-0118-1

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