Surgical paper XII
Adult retroperitoneal teratoma infection complicated with chronic purulent fistula
A Case Report
A 53-year-old female patient presented with a history of left waist swelling, pain, fever, and pus discharge that occurred 12 years ago and reportedly “self-healed” within a few months. Six years prior to the current consultation, she developed an abscess on the medial aspect of her left thigh, which was incised to create a fistula but never fully healed.
Upon examination, the patient appeared to be suffering from chronic consumptive anemia. She had purulent fistulas in both the right lumbar and left femoral regions, discharging yellowish fluid and some pus. Radiographic evaluations showed no abnormalities in the spine, pelvis, or hip joints. However, the shadow of the left psoas muscle appeared indistinct. No evidence of an intestinal fistula was found through contrast studies. A 4.5 cm irregular residual barium shadow was noted near the second and third lumbar vertebrae, appearing potato-like. Biopsy of the fistula tissue revealed inflammatory granulation.
Immediate surgical exploration was carried out, confirming that the fistula tract led into the left psoas muscle. Upon injecting methylene blue into the fistula and subsequently incising the muscle, thin pus was drained. The abscess cavity was spindle-shaped, measuring approximately 20x5x4 cm. Tracking the cavity upwards led to the discovery of a 6x5x4 cm encapsulated mass near the second and third lumbar vertebrae. The mass was easily excised. It was adherent to and penetrated the psoas major muscle. The intramuscular abscess was fully incised, its inner wall scraped clean of granulation tissue, washed, and hemostasis was achieved through compression.
The pathological examination confirmed a benign cystic teratoma complicated by infection, leading to the formation of a left psoas muscle abscess and an external fistula.
This article was originally published in Journal of Transportation Medicine,1993；Vol.7, fourth (368) Changhang Hospital, Li Mingjie