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Retroperitoneal inflammation

Retroperitonitis

Retroperitoneal inflammation causes swelling that occurs in the retroperitoneal space. Over time, it can lead to a mass behind the abdomen and its contents called retroperitoneal fibrosis.

The retroperitoneal space is in front of the lower back and behind the abdominal lining (peritoneum). Organs in this space include the:

• Kidneys
• Lymph nodes
• Pancreas
• Spleen
• Ureters

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Causes

Retroperitoneal inflammation and fibrosis is a rare condition. There is no clear cause in about 70% of cases. It most likely develops due to inflammation of the abdominal aortic artery.

Conditions that can rarely lead to this include:

• Abdominal radiation therapy for cancer
• Cancer -- bladder, breast, colon, lymphoma, prostate, sarcoma
• Carcinoid tumor
• Crohn disease
• Infections -- tuberculosis, histoplasmosis
• Certain medicines, such as methysergide, ergotamine, pergolide, methyldopa, etanercept and infliximab
• Surgery of structures in the retroperitoneum

Symptoms

Symptoms include:

• Abdominal pain
• Anorexia
• Flank pain
• Low back pain
• Malaise

Exams and Tests

Your health care provider usually diagnoses the condition based on a CT scan or ultrasound exam of your abdomen. A biopsy of tissues in your abdomen may be needed.

Treatment

Treatment depends on the underlying cause of retroperitoneal inflammation and fibrosis.

Outlook (Prognosis)

How well you do with the condition depends on the underlying cause. It can lead to kidney failure.

References

Mathews JB, Turaga K. Surgical peritonitis and other diseases of the peritoneum, mesentery, omentum, and diaphragm. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 39.

McQuaid KR. Approach to the patient with gastrointestinal disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 123. 

Mettler FA, Guiberteau MJ. Inflammation and infection imaging. In: Mettler FA, Guiberteau MJ, eds. Essentials of Nuclear Medicine and Molecular Imaging. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 12.

Privratsky AM, Barreto JC, Turnage RH. Abdominal wall, umbilicus, peritoneum, mesenteries, omentum, and retroperitoneum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 44.

Review Date: 12/4/2022  

Reviewed By: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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