title: Midline extraperitoneal approach for bilateral widespread retroperitoneal abscess originating from anorectal infection.
abstract: BACKGROUND
  Anorectal abscess is one of the most common anorectal conditions encountered in practice. However, such abscesses may rarely extend upward and cause life-threatening medical conditions.
  
  
  METHODS
  A 53-year-old woman presented with symptoms of anorectal abscess and evidence of severe inflammatory response and acute kidney injury. Computed tomography revealed a widespread abscess extending to the bilateral retroperitoneal spaces. Surgical drainage was performed via a totally extraperitoneal approach through a lower midline abdominal incision, and the patient had a rapid and uncomplicated recovery.
  
  
  CONCLUSIONS
  Although retroperitoneal abscesses originating from the anorectal region are rare, they are life-threating events that require immediate treatment. Percutaneous abscess drainage has been recently evolved; however, surgical drainage is required sometimes that may be challenging, particularly in the case of widespread abscesses, as in our case.
  
  
  CONCLUSIONS
  The midline extraperitoneal approach reported here might be an effective surgical option for patients with bilateral widespread retroperitoneal abscesses.
authors.affiliation: Department of Surgery, Sapporo City General Hospital, 13-1-1 Kita Juichijo Nishi Chuo-ku Sapporo, Hokkaido 060-8604, Japan. Electronic address: koji.okuda@jcom.home.ne.jp.
authors.forename: Koji
authors.initials: K
authors.lastname: Okuda
authors.affiliation: Department of Surgery, Sapporo City General Hospital, 13-1-1 Kita Juichijo Nishi Chuo-ku Sapporo, Hokkaido 060-8604, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Oshima
authors.affiliation: Department of Surgery, Sapporo City General Hospital, 13-1-1 Kita Juichijo Nishi Chuo-ku Sapporo, Hokkaido 060-8604, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Saito
authors.affiliation: Department of Surgery, Sapporo City General Hospital, 13-1-1 Kita Juichijo Nishi Chuo-ku Sapporo, Hokkaido 060-8604, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Uesaka
authors.affiliation: Department of Surgery, Sapporo City General Hospital, 13-1-1 Kita Juichijo Nishi Chuo-ku Sapporo, Hokkaido 060-8604, Japan.
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Terasaki
authors.affiliation: Department of Surgery, Sapporo City General Hospital, 13-1-1 Kita Juichijo Nishi Chuo-ku Sapporo, Hokkaido 060-8604, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Kasai
authors.affiliation: Department of Surgery, Sapporo City General Hospital, 13-1-1 Kita Juichijo Nishi Chuo-ku Sapporo, Hokkaido 060-8604, Japan.
authors.forename: Nozomi
authors.initials: N
authors.lastname: Minagawa
authors.affiliation: Department of Surgery, Sapporo City General Hospital, 13-1-1 Kita Juichijo Nishi Chuo-ku Sapporo, Hokkaido 060-8604, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Oshima
authors.affiliation: Department of Surgery, Sapporo City General Hospital, 13-1-1 Kita Juichijo Nishi Chuo-ku Sapporo, Hokkaido 060-8604, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Okawa
authors.affiliation: Department of Surgery, Sapporo City General Hospital, 13-1-1 Kita Juichijo Nishi Chuo-ku Sapporo, Hokkaido 060-8604, Japan.
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Misawa
keywords: Anorectal abscess; Lower abdominal incision; Midline extraperitoneal approach; Retroperitoneal abscess; Surgical drainage