Extensive Wound Management of a Retroperitoneal Abscess Due to Complicated Pyelonephritis in a Patient With Type 2 Diabetes: A Case Report

Complicated urinary tract infections can progress to deep-seated abscesses, particularly in patients with comorbidities such as type 2 diabetes mellitus. These infections may result in severe soft tissue damage and require a complex, comprehensive and multidisciplinary approach to achieve favorable clinical outcomes. A 42-year-old male with poorly controlled type 2 diabetes mellitus developed a retroperitoneal abscess secondary to pyelonephritis, extending to the psoas muscle with cutaneous exteriorization in the left thigh region. Upon admission, he presented with an extensive purulent wound, hypoalbuminemia, and electrolyte imbalances. Management included antibiotic therapy, nutritional support, local wound care with negative pressure therapy, and acetic acid. A split-thickness skin graft was later performed, with successful integration. The patient experienced a favorable clinical course, with progressive functional recovery and no infectious complications. This case highlights the importance of a comprehensive and staged approach in managing complex wounds resulting from deep infections in vulnerable patients. The combination of local antimicrobial treatment, negative pressure therapy, and skin grafting enabled effective recovery, without the need for extensive surgical interventions.