Lactology Foundation

Retroperitoneal Pain

Pain that originates from the retroperitoneal region generally radiates to the back, the lumbar region on both sides of the spinal column, and, more rarely, to the flanks and ventrally.
Spinal diseases must be excluded first.

Classification. Retroperitoneal pain can be classified as
follows:
➤ acute or chronic
➤ caused by benign or malignant diseases
➤ caused by renal or non-renal diseases.
The transitions are smooth, particularly because ureteral blockage is a very common cause of retroperitoneal pain, and can generally be diagnosed by sonography, intravenous urography, CT or MRI.
Causes. Important causes are:
➤ nephrolithiasis or urolithiasis with typical ureteral colic
➤ papillary necrosis
➤ hydronephrosis of various etiologies.

Retroperitoneal Fibrosis
The clinical picture of retroperitoneal fibrosis can be associated with severe lower back pain.
It can be classified into:
➤ the idiopathic form: Ormond disease
➤ symptomatic retroperitoneal fibrosis: Ormond-like alterations resulting from:
− inflammatory processes (e.g., pancreatitis, distal ileitis, diverticulitis, tuberculous spondylitis, appendicitis, inflammatory aortic aneurysm)
− tumors (malignant lymphomas, lymph node metastases [e.g., testicular tumors, consequences of radiation therapy])
− certain drugs (e. g., methysergide).
The fibrosis may result in unilateral or bilateral ureteral obstruction with the corresponding consequences.
Differential Diagnosis
If there is no ureteral obstruction, the following causes of retroperitoneal pain must be considered:
➤ acute appendicitis of retroperitoneal appendix
➤ psoas abscess
➤ renal infarction
➤ retroperitoneal hematoma (e.g., in patients receiving
anticoagulants)
➤ Wilms tumors (in children)
➤ aortic dissection
➤ vertebrogenic causes (disk disease, spondylitis).