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.
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
Most patients are either known for a systemic illness (diabetes, 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
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
Early recognition is important, as early treatment and debridement may help the poor clinical outcome usually associated with this entity.
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