肾自截伴流注脓肿1例报道并文献回顾

目的 了解肾结核导致流注脓肿患者的临床表现、诊断、治疗及预后.方法 对川北医学院附属医院骨科诊断的1例肾自截伴流注脓肿患者的临床表现、实验室及影像学检查、治疗和预后进行分析,并回顾和总结国内外迄今为止关于肾结核致腰大肌脓肿的文献报道.结果 该例71岁女性患者以腰背部疼痛伴右臀部、右大腿根部包块处红肿热痛为主要症状,有低...

Autonephrectomy complicated with gravitation cold abscess:a case report and literature review

Objective To understand the clinical manifestation,diagnosis,treatment and prognosis of patients with gravitation cold abscess caused by renal tuberculosis.Methods The clinical manifestation,laboratory and imaging examination,treatment and prognosis of a patient with autonephrectomy complicated with gravitation cold abscess diagnosed in the orthopedics department of the affiliated hospital of north Sichuan medical college were analyzed.The literature reports on psoas abscess callsed by renal tuberculosis at home and abroad so far were reviewed and summarized.Results The patient was a 71-years-old woman with low back pain,swelling and hot pain at the right buttocks and right thigh root mass as the main symptoms;she had symptoms of low fever,sweating and general fatigue,but no frequent urination,urgent urination,hematuria and pyuria.Combined with medical history,imaging and pathological examination,the patient was considered to have autonephrectomy caused by right renal tuberculosis combined with abscess at the right psoas muscle,iliac fossa,groin and thigh root with bacterial infection.After anti-tuberculosis drug treatment and abscess incision and drainage,the patients'condition improved.A total of 9 articles and 22 patients were collected by reviewing the previous literature,and there were 23 patients after adding 1 case this time,including 12 women and 11 men.Most of the patients were young and middle-aged,and most of them had no bladder irritation sign.Among the patients,20 cases were diagnosed by histopathological examination,and 3 cases were diagnosed by acid fast staining(two case were drainage fluid and one case was urine).Most patients improved after antituberculous drug treatment,abscess drainage and excision of affected kidney,while only one case recurred because of stopping antituberculous drug treatment during follow-up.Conclusion Psoas abscess caused by renal tuberculosis is very rare,autonephrectomy complicated with gravitation cold abscess reported in this paper is extremely rare,which is the result of renal tuberculosis development to the late perirenal invasion.Most of these patients are treated for low back pain or mass,and most of them have no bladder irritation sign.The key to prevention is early diagnosis and treatment,and the treatment is mainly surgery supplemented by antituberculous drugs,in which sufficient course of antituberculous drug treatment is the key to avoid recurrence.