tailieunhanh - Chapter 121. Intraabdominal Infections and Abscesses (Part 9)

Candida spp. can cause renal abscesses. This fungus may spread to the kidney hematogenously or by ascension from the bladder. The hallmark of the latter route of infection is ureteral obstruction with large fungal balls. The presentation of perinephric and renal abscesses is quite nonspecific. Flank pain and abdominal pain are common. At least 50% of patients are febrile. Pain may be referred to the groin or leg, particularly with extension of infection. The diagnosis of perinephric abscess, like that of splenic abscess, is frequently delayed, and the mortality rate in some series is appreciable, although lower than in the. | Chapter 121. Intraabdominal Infections and Abscesses Part 9 Candida spp. can cause renal abscesses. This fungus may spread to the kidney hematogenously or by ascension from the bladder. The hallmark of the latter route of infection is ureteral obstruction with large fungal balls. The presentation of perinephric and renal abscesses is quite nonspecific. Flank pain and abdominal pain are common. At least 50 of patients are febrile. Pain may be referred to the groin or leg particularly with extension of infection. The diagnosis of perinephric abscess like that of splenic abscess is frequently delayed and the mortality rate in some series is appreciable although lower than in the past. Perinephric or renal abscess should be most seriously considered when a patient presents with symptoms and signs of pyelonephritis and remains febrile after 4 or 5 days of treatment. Moreover when a urine culture yields a polymicrobial flora when a patient is known to have renal stones or when fever and pyuria coexist with a sterile urine culture these diagnoses should be entertained. Renal ultrasonography and abdominal CT are the most useful diagnostic modalities. If a renal or perinephric abscess is diagnosed nephrolithiasis should be excluded especially when a high urinary pH suggests the presence of a ureasplitting organism. Perinephric and Renal Abscesses Treatment Treatment for perinephric and renal abscesses like that for other intraabdominal abscesses includes drainage of pus and antibiotic therapy directed at the organism s recovered. For perinephric abscesses percutaneous drainage is usually successful. Psoas Abscesses The psoas muscle is another location in which abscesses are encountered. Psoas abscesses may arise from a hematogenous source by contiguous spread from an intraabdominal or pelvic process or by contiguous spread from nearby bony structures . vertebral bodies . Associated osteomyelitis due to spread from bone to muscle or from muscle to bone is common in psoas