Perinephric abscess. Modern diagnosis and treatment in 47 cases

摘要: The records of 47 patients with a perinephric abscess diagnosed from 1975 to 1986 at 8 San Francisco Bay Area hospitals were reviewed. mean age was 51 years. Fifty-five percent females and 45%, males. left kidney affected in 47% cases, the right 40%, both 4%, transplanted pelvic 9%. Fever (55%), chills or diaphoresis (47%), flank pain (40%), abdominal nausea vomiting (32%) most common presenting symptoms. About half had symptoms for 1 week less 12% no documented before diagnosis 88% patients. Abdominal mass (13%) tenderness (49%), (9%) (42%) seen frequently, 11% did not have fever, flank, findings. frequent underlying conditions included previous urologic surgery (45%), urinary tract infection (38%), diabetes mellitus (36%), stones (36%). Cultures abscesses yielded gram-negative aerobes 52% patients, primarily Escherichia coli. Staphylococcus aureus isolated 26% anaerobes 17%. A single pathogen 71% multiple isolates 29%. Of interest great potential therapeutic importance culture anaerobes, Bacteroides spp. 17%, Enterococcus 7%, Candida albicans 7%. Positive blood urine cultures identified organisms exactly 58% 37% respectively. Routine laboratory tests such as white cell count urinalysis insensitive non-specific abscess. Leukocytosis anemia admission slightly more than For radiologic diagnosis, computerized tomographic scanning helpful. Ultrasound intravenous pyelography falsely negative about one-third cases. Mortality low this series when compared earlier studies, probably reflects modern medical care. Six died during hospitalization, 2 whom PNA established only autopsy. Drainage carried out by open surgical drainage 64% percutaneous 19%, 13%. initial procedure, whether catheter drainage, usually successful. Late complications nephrocutaneous fistulas 3 disseminated candidiasis patient.