A Refractory Abscess of the Adrenal Gland Associated with Suboptimal Indwelling Catheter Management in a Diabetic Patient

Peng Yu, MD, PhD, Kathleen Hromatka, MD, Alan Posner, MD. Department of Surgery, SUNY Buffalo, Kaleida Health System, Buffalo, NY

INTRODUCTION: Adrenal gland abscess is an extremely rare finding in adults. We present a case of a refractory adrenal abscess likely secondary to inadequate drainage of an adrenal cyst. 

CASE: The patient is a 53-year-old female with a history of poorly controlled type 2 diabetes and prior treatment of a non-functioning, benign cyst of the left adrenal gland. In Singapore in 2016, the patient underwent four separate episodes of percutaneous aspiration and drainage with an indwelling catheter. Shortly after immigrating to the U.S. in February 2017, she was admitted to our facility with flank pain and a non-healing draining sinus at the prior left flank drain site without significant systematic symptoms.  CT images confirmed a 4 x 5 x 7 cm³ left suprarenal fluid collection with a calcified rim (Figures 1-3).  An ultrasound-guided percutaneous drainage obtained 40 mL of purulent fluid, and an indwelling drain catheter was placed.  The drain fluid was cultured and found to be positive for Methicillin-sensitive staphylococcus aureus.  The patient was treated with a course of antibiotics and discharged home.  The patient demonstrated poor compliance with care of her drain catheter and the adrenal abscess persisted on follow-up CT imaging (sizing 4.2 x 4.4 x 4.7 cm³).  Subsequently, the patient elected to undergo a laparoscopic left adrenalectomy with excision of associated adrenal abscess in April 2017 after establishing care with a primary care physician and optimizing her diabetic control.  The procedure and postoperative course were uneventful and the patient recovered well.  Pathology revealed benign inflammation of the left adrenal gland, with necrosis, calcification and fibrotic changes in the para-adrenal tissue.

DISCUSSION: There are few instances of adrenal gland abscess reported in the literature.  Our patient has a recent surgical history of multiple percutaneous aspiration and indwelling catheter drainages for a symptomatic benign adrenal cyst.  Her uncontrolled diabetes and noncompliance with instructions for drain care likely contributed to her development of a refractory adrenal abscess.  This case highlights the importance of prudent decision making with regards to electing to drain adrenal gland pathology, as well as vigilant management of indwelling catheters.

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Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 86279

Program Number: P150

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster