In our patient, the retained fragment was embedded in the wall of an abscess located retroperitoneally in his iliopsoas muscle. When considering the proximity of the iliopsoas muscle to the digestive tract, urinary tract, and iliac lymph nodes, it is reasonable for infectious material to come in contact with the foreign body from these nearby structures, resulting in secondary infection.11 Surgery was previously considered the first-line treatment for retroperitoneal abscesses until the advent of imaging-guided percutaneous drainage.12
In some instances, surgical drainage may still be attempted, such as if there are different disease processes requiring open surgery or if percutaneous catheter drainage is not technically possible due to the location of the abscess, thick exudate, loculation/septations, or phlegmon. In these cases, laparoscopic drainage as opposed to open surgical drainage can provide the benefits of an open procedure (ie, total drainage and resection of infected tissue) but is less invasive, requires a smaller incision, and heals faster.13 Percutaneous drainage is the current first-line treatment due to the lack of need for general anesthesia, lower cost, and better morbidity and mortality outcomes compared to surgical methods.12 While percutaneous drainage proved to be immediately therapeutic for our patient, the risk of abscess recurrence with the retained infected fragment necessitated coordination of procedures across specialties to provide the best outcome for the patient.
Conclusions
This case demonstrates a multidisciplinary approach to transforming an otherwise large retroperitoneal dissection to a minimally invasive and technically efficient abscess drainage and foreign body retrieval.