Retroperitoneal fasciitis

Last revised by Arlene Campos on 10 May 2024

Retroperitoneal fasciitis (rare plural: retroperitoneal fasciitides) 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, maybe necrotizing.

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 spreads through fascial planes, from the retroperitoneal and/or extraperitoneal spaces.

Main clinical features include:

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 spp.
  • Clostridium spp.
  • Escherichia coli
  • Klebsiella pneumoniae
  • anerobic Streptococci spp.

CT is the main modality with which retroperitoneal fasciitis is diagnosed. It mainly consists of a variable degree of asymmetrical retroperitoneal fat stranding and fascial enhancement. Other features include:

Early recognition is important, as early treatment and debridement may help the poor clinical outcome usually associated with this entity.

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