Right Pelvic Abscess

September 14, 2005
Robert P. Blereau, MD

Two days of pain in his right leg, which had been swollen for a week, brought this 69-year-old man with type II diabetes to the emergency department (ED). Three months earlier, the patient had undergone a radical retropubic prostatectomy with bilateral pelvic lymph node dissection. Examination in the ED revealed an edematous right leg indurated with a leathery-appearing thigh that was hot to the touch. His temperature was 38.7°C (101.7°F), and his white blood cell count was 21,290/µL with a shift to the left.

Two days of pain in his right leg, which had been swollen for a week, brought this 69-year-old man with type II diabetes to the emergency department (ED). Three months earlier, the patient had undergone a radical retropubic prostatectomy with bilateral pelvic lymph node dissection. Examination in the ED revealed an edematous right leg indurated with a leathery-appearing thigh that was hot to the touch. His temperature was 38.7°C (101.7°F), and his white blood cell count was 21,290/µL with a shift to the left.

A CT scan of the pelvis (seen here) demonstrated a right pelvic abscess impinging laterally on the psoas major muscle and medially on the iliac vein. Within a few days, massive edema of the genitalia developed.

Robert P. Blereau, MD of Morgan City, La, reports that 200 mL of pus was aspirated via a catheter inserted retroperitoneally through the right lower abdomen, but a culture revealed no growth. Progressively decreasing purulent drainage was evacuated through the catheter. The patient's massive genital and right leg edema, as well as the fever, resolved a few days after insertion of the catheter.

Intravenous cefazolin therapy was initiated in the hospital and continued for 2 weeks; oral cephalexin was given following discharge until the catheter spontaneously extruded 1 month after placement.

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