Case Report: Dissecting Retroperitoneal Abscess with Gas Formation

Presenting as a case to the emergency department was a 53-year-old male with a complaint of diffuse abdominal pain and focal right flank pain at site of recent percutaneous abscess drain site performed exactly one month prior. This followed hospitalization in the preceding year for complicated multifocal intra-abdominal infections requiring surgical interventions including exploratory laparotomy and surgical debridement for intra-abdominal abscess and scrotal abscess formation. Despite prior aggressive management and extensive coverage with broad-spectrum antibiotics, this patient was found to have fulminant recurrance of infection in the right retroperitoneal space with an expanding abscess dissecting through the retroperitoneal structures into the abdominal wall musculature. The patient was hospitalized for sepsis secondary to this infection, with escalating antibiotic therapy and replacement of a percutaneous drain at the retroperitoneal focus of abscess formation. While the management was complex, this patient ultimately made a recovery and was discharged after the fourth day of hospitalization. However, this case does highlight the importance of early recognition and treatment of an aggressive and rapidly developing infection, and the unusual evolution of a gas-forming abscess with dissecting features.