Retroperitoneal fasciitis
Retroperitoneal fasciitis is a rare potentially life-threatening infection of the retroperitoneum. It is the retroperitoneal equivalent of necrotizing fasciitis or non-necrotizing soft tissue fasciitis, and just like its soft tissue counterpart, can also be either necrotizing or not.
Clinical presentation
Most patients are either known for a systemic illness (diabetes mellitus, neoplasm, etc.), are in a recent postoperative setting or have lower extremity fasciitis, all of which predispose to the development of retroperitoneal fasciitis. Infection is spreading through fascial planes, from retroperitoneal/extraperitoneal spaces.
Main clinical feature include:
- severe abdominal pain
- alteration of consciousness
- shock
Pathology
Etiology
Retroperitoneal fasciitis is usually infectious and polymicrobial in origin. It may occur secondarily to extraperitoneal spread of intra-abdominal infections, including common processes such as acute diverticulitis or acute appendicitis. It may also spread directly or indirectly from lower limb soft tissue fasciitis. Known organisms include:
- Bacteroides specie
- Clostridium specie
- Escherichia coli
- Klebsiella pneumoniae
- anerobic streptococci
Radiographic features
CT
CT-scan is the main modality on which retroperitoneal fasciitis is diagnosed. It mainly consists of a variable degree of asymmetrical retroperitoneal fat stranding and fascial enhancement. Other features include:
- retroperitoneal gas (retropneumoperitoneum)
- nonfocal retroperitoneal collections - including intrafascial collections
- vascular thrombosis - in severe cases
Treatment and prognosis
Early recognition is important, as early treatment and debridement may help the poor clinical outcome usually associated with this entity.
Differential diagnosis
