| Our patient was a 77-year-old woman with no known drug allergies and a history of pathological cardiomyopathy, arthrosis, hysterectomy and double adnexectomy plus chemotherapy and radiotherapy for a gynecologic tumor 12 years ago. | |
| She came to the emergency department for presenting colic pain of eight days of evolution located in the right lumbar fossa and flank as well as in the anterior face of the right thigh increasing with walking. | |
| In turn, the pain is accompanied by nausea and vomiting. | |
| The patient presented fever peaks with professional sweating, although at the moment she came to the emergency room she was afflicted and did not present voiding syndrome. | |
| The physical examination showed: apexic pro-tomesystolic murmur, blando and presible abdomen, painful upon palpation of the iliac fossa and right flank. | |
| It also highlights spontaneous pain in the anterior aspect of the right thigh that increases with pressure and limb mobility. | |
| Emergency laboratory tests showed leukocytosis with left shift (17,200 leukocytes with 84% neutrophils), 567,000 platelets, urea 1,35, creatinine 1,80. | |
| Urinary tract x-rays and ultrasound are requested as imaging tests in those cases where there is a graphic image in the right renal pelvis and ectasia located right foot. | |
| With the diagnosis of complicated right nephritic colic was decided admission for urinary diversion and intravenous antibiotic treatment. | |
| An external catheter was placed in the operating room in the right ureter with abundant clean urine output. | |
| Over the course of the days, colic pain ceases, although the patient reports deaf pain in the lumbar fossa and continues with pain in the right thigh. | |
| The patient was assessed by the Traumatology Department, who prescribed anticonvulsant medication for suspected quadruple rupture. | |
| Due to the persistence of low back pain, it was decided to perform an ultrasound examination, finding a mass located in the right psoas muscle of 10 x 5.5 cm. A CT scan was requested. | |
| CT confirmed the presence of retroperitoneal abscess in the compartment of the right iliac psoas muscle at L2-L3 level without losing continuity to the inguinal ring third and without ruling out the participation of the right ureter. | |
| Once the diagnosis was confirmed, we contacted the Department of Interventional Radiology for percutaneous drainage. | |
| A 10 Fr catheter was placed on a median ultrasound, evacuating 200 cc. purulent material, from which a microbiological sample was sent (the presence of Bacteriodes fragilis and Streptococcus sanguis was confirmed on successive days). | |
| Drainage output is progressively lower and a new CT scan is performed, showing a decrease in abscess volume. | |
| It was decided to remove the drainage tube on the fifth day after placement, but it was necessary to replace the catheter 14 fr. due to clinical worsening. | |
| The existence of a primary focus is unknown, as it is requested during admission to try to find a digestive origin of the problem. | |
| It is not possible to exceed the splenic angle so there is no primary focus. | |
| From the urological point of view, the appearance of the abscess is not justified either. | |
| Cavitogram was performed to study the morphology and size of the abscess and intrafamilial fibrinolytic lavage was indicated (100,000 units of urokinase in 10 cc of normal saline). | |
| After one month and ten days of admission, the patient is discharged with clinical improvement confirmed by imaging techniques. | |
| In subsequent follow-up visits, the patient is asymptomatic with complete resolution of the process. | |