Surgial management of adrenal abscess after transabdominal biopsyc
Bulátkó Balázs dr., Domján István dr.
Szabolcs-Szatmár-Bereg Megyei Kórházak és Egyetemi Oktatókórház – Jósa András Oktatókórház – Urológiai Osztály, Nyíregyháza (osztályvezető: Adányi József dr.)
Introduction: Adrenal abscess is a rare entity in adults that usually develops by haematogenous dissemination as a consequence of a systemic infection, but may also occur as an iatrogenic lesion.
Case study: A 48-year-old female patient was being examined for atypical lower abdominal symptoms. Abdominal ultrasonography identified multiplex, simplex liver and kidney cysts, and in addition, a cystic lesion of uncertain dignity was described in the left adrenal region. A contrast enhanced abdominal and pelvic CT scan was also performed, which raised suspicion of malignancy. An interventional radiologist performed an ultrasound-guided transabdominal biopsy. Following the sampling, the patient developed a severe septic condition, the recognition of which was delayed because the complaints and symptoms were atypical and the possible causative role of the earlier biopsy was overlooked. The newly formed adrenal abscess was drained. Following the recovery of the sepsis, we opted for surgical exploration. Considering the extensive size of the lesion, a transperitoneal approach was used, and the extremely enlarged abscessed adrenal gland was successfully removed. The patient subsequently recovered without any complications.
Conclusion: It is recommended that non-endocrine evaluation of adrenal lesions and, if necessary, biopsy and surgery should be performed in departments with considerable experience in transperitoneal and retroperitoneal surgery, diagnostic procedures and sampling.