Perinephric abscesses in the pediatric population: case presentation and review of the literature.

BACKGROUND: Perinephric abscesses in children are rare. Infection can come from various areas, and clinical signs overlap with more common etiologies, such as pyelonephritis. Imaging modalities and laboratory investigations help lead to a definitive diagnosis.

CASE-DIAGNOSIS/TREATMENT: We present a case of a 5-month-old infant presenting with a febrile illness and eventual diagnosis of a perinephric abscess causing abdominal compartment syndrome. The infant had no known risk factors, i.e., congenital genitourinal abnormalities or immunosuppression, and was treated successfully following initial resuscitation, appropriate antibiotics, and open surgical drainage. Cultures obtained from the abscess and peritoneal fluid were positive for S. aureus, while blood and urine cultures were negative.

CONCLUSIONS: A literature review found 13 studies looking at diagnosis and/or treatment of idiopathic perinephric abscess. With non-specific clinical signs and symptoms, diagnosis can be delayed and rests heavily on clinical suspicion and appropriate imaging. Treatment includes antibiotics alone, or in conjunction with percutaneous or open surgical drainage. In summarizing these studies, a suggestion for diagnosis and basic treatment approach is outlined.