Retroperitoneal and retrofascial abscesses. A review.

The anatomy of retrofascial and retroperitoneal abscesses is not widely understood by orthopaedic surgeons because these abscesses are encountered infrequently and may cause symptoms at their points of extension rather than at their origin. Recent developments in bone-imaging and computed tomographic scanning have made it easier to diagnose and treat these abscesses and to identify their origins. These same diagnostic techniques have also made it easier to distinguish retrofascial from retroperitoneal abscesses. In this paper we define the retrofascial and retroperitoneal spaces, enumerate the possible sources of infection and the pathways of drainage, identify the pelvic spaces where the abscesses collect, and list the peripheral extrapelvic areas where these abscesses cause symptoms. The clinical signs and symptoms of retrofascial and retroperitoneal infection differ from those of osseous infection of the pelvis and spine, the two most common sources of retrofascial infection. The diagnostic value of the various radiographic methods is discussed, the prognoses for various types of abscesses are reported, and approaches to treatment are presented.