[Psoas abscess caused by Salmonella enteritidis: presentation of a case]

The psoas abscess is an entity of infrequent occurrence in daily clinical practice. Many pathogens have been related with the genesis of this focal infections, but it can be said nowadays that the Staphylococcus aureus is more often involved in them. We present the case of a male aged 26, with a culture of purulent drained material, where Salmonella enteritidis, a microorganism of exceptional presentation in this pathology, was isolde. Moreover, some hypothesis have been proposed about the possible physiopathology and the current state of the diagnostic and therapeutic techniques in these processes is revised.

[Spondylogenic psoas abscess: long-term follow-up after percutaneous drainage]

Iliopsoas abscesses originating from bacterial lumbar spondylodiscitis were successfully treated by CT-guided percutaneous abscess drainage, antibiotics, and immobilization in two patients. Vertebral fusion of the affected segments was observed in both patients in the follow-up period (1 and 6 years, respectively). Percutaneous abscess drainage can replace surgery for iliopsoas abscesses following vertebral osteomyelitis.

[Psoas abscess mimicking septic arthritis of the hip]

Primary psoas abscess is a relatively rare and imposes diagnostic and therapeutic challenges. We describe a 16-year-old boy who presented with fever, limp and the clinical picture of septic arthritis of the hip joint. He did not respond to conventional medical treatment. When the diagnosis of psoas abscess was made and the abscess was drained, he gradually recovered. The diagnosis of psoas abscess is frequently missed. Correct diagnosis is very important because usually, cure only follows surgical drainage.

[CT-guided percutaneous drainage in the management of psoas abscesses]

The authors review their first experiences in Hungary with the CT guided percutaneous catheter treatment of psoas abscesses. Diagnostic aspiration from abscess was performed in one patient. Percutaneous catheter drainage of psoas abscess were performed in 4 patients. There were 4 patients with unilateral and 1 patient with bilateral psoas abscess. 4 patients had tuberculous spondylodiscitis, 1 patient had staphylococcal vertebral osteomyelitis. One patient following diagnostic aspiration was successfully treated with antituberculoutic drugs. All patient treated with percutaneous catheter drainage received medical antituberculoutic or antibiotic therapy and showed excellent clinical and radiological results. There was no complication and there was no need to open surgical drainage in this series. CT guided aspiration is a valuable tool in the diagnosis of psoas abscesses as well as in the identification of the exact abscess etiology. Percutaneous drainage represents an efficient and attractive alternative to open surgical drainage in the treatment of psoas abscesses.

The diagnosis and treatment of psoas abscess: a 12 year review

Over a 12 year period, 25 psoas abscesses occurring in 17 patients were managed at Royal Perth Hospital (900 bed hospital). Symptoms were present, on average, for 5 weeks prior to diagnosis, which was typically confirmed by computerized tomography. Fifty-nine per cent of cases were primary and percutaneous drainage effected a cure in 80% of all cases. Percutaneous drainage resulted in a non-significant trend towards shorter inpatient stay.

Abdominal tuberculosis. A report of 3 cases

Three patients admitted to the surgical wards of Johannesburg Hospital in whom abdominal tuberculosis was suspected are presented. In every case difficulties were encountered in diagnosis and treatment. Each case presentation is followed by a short commentary on relevant aspects of abdominal tuberculosis.

[Psoas abscess exteriorized in the groin revealed late after acute pancreatitis]

Two cases of psoas abscess complicating acute necrotizing pancreatitis are reported. These cases were particular because the abscesses exteriorized in the groin and symptoms were misleading. The abscesses were detected late, three and five months after the beginning of the pancreatitis respectively. The difficulties in diagnosis and the long delay to diagnosis are emphasized as possible sources of superinfection.

Pyomyositis in children

Bacterial infections of muscle, also known as pyomyositis or tropical pyomyositis, occur more commonly in tropical regions. This article reviews five cases of pyomyositis diagnosed in children over a 1-year period. Pyomyositis should be considered in the differential diagnosis of septic-appearing children as well as children complaining of joint pain or muscle aches. The diagnosis can be aided with either a computed tomography (CT) or magnetic resonance imaging (MRI) scan. The MRI is preferable because multiple processes can be evaluated, such as joint effusion suggesting septic arthritis. If the patient does not respond quickly to antibiotics and surgical intervention, either there is a recurrence of the previously debrided abscess, or there is an unrecognized secondary abscess. Multiple abscess sites should be entertained prior to initial debridement.

Osteomyelitis of the spine due to Salmonella: case report, review of clinical aspects, pathogenesis and treatment

Osteomyelitis of the spine caused by Salmonella is rare. The authors describe a case in which the patient had fusion of the L1 and L2 vertebrae, which were affected by osteomyelitis. The infecting organism was Salmonella typhimurium. The authors describe the relationship of the vascular anatomy to the development of osteomyelitis of the spine. They discuss the clinical features, diagnosis, pathogenesis and treatment of the disease. Although the association of osteomyelitis due to Salmonella and sickle cell disease has long been known, this patient did not have sickle cell disease or any other condition that would compromise the immune system.

[Psoas abscesses--still a current problem in Denmark]

Two cases of secondary, non-tuberculous psoas abscesses are presented, stressing that psoas abscesses are not restricted to tuberculous diseases of the spine (Pott's disease). In one case, the aetiology was diverticulitis with perforation located to the left colonic flexure. The patient was treated by a two-step operative procedure creating drainage and a primary anastomosis, which in the post-operative course was leaking. The patient died because of recurrent abscess formation and sepsis. The other patient received an aorto-bifemoral prosthesis two years prior to the current hospitalisation, and a bilateral psoas abscess appeared in the presence of this prosthesis. In both cases, the psoas abscesses presented below the inguinal ligament before diagnosis was made and even in the latter case with a delay of several months.

Late presentation of infection as a complication of Dwyer anterior spinal instrumentation

Delayed presentation of infection is a rare complication of anterior instrumentation and fusion for scoliosis. Three cases that followed the Dwyer procedure are reported. Pain was absent in these patients, but mild constitutional symptoms were present. An elevated erythrocyte sedimentation rate (ESR) is an important indicator of this complication. Two patients developed groin abscesses and sinuses as the hallmark of deep infection. Infection resolved after removal of instrumentation and local debridement.

[A xanthogranulomatous psoas abscess 4 years after nephrectomy for xanthogranulomatous pyelonephritis]

We report a case of xanthogranulomatous abscess of the left psoas muscle in a patient who underwent nephrectomy for xanthogranulomatous pyelonephritis four years earlier. Pathogens unlike those usually found in this type of inflammatory reaction were grown on culture. The possible relationship between the two infectious disease processes is analyzed.

Psoas abscess following ingestion of psoas

A case of right psoas abscess that was caused by duodenal perforation following the ingestion of a wooden skewer from a filet mignon is presented. Surgical repair of the perforation, drainage of the abscess and 5 days of intravenous antibiotics resulted in prompt recovery.

Latent psoas abscess after anterior spinal fusion

This case is presented to emphasize that late infection should be considered in all postoperative patients as a cause of pain. A psoas abscess may remain dormant for many years after an anterior spinal procedure. It should be considered in the differential diagnosis of back pain and lumbar radiculopathy after anterior spinal fusion. The lumbar nerve plexus lies within the psoas muscle, and referred pain patterns may occur in the lumbar nerve distribution. In this case, dysesthesias occurred in the distribution of the genitofemoral nerve. The diagnosis and treatment of a psoas abscess has been greatly aided by use of CT and ultrasound. Either of these modalities may be used for directed percutaneous drainage of the abscess. The presence of metal fixation devices necessitates removal of the hardware in order to ensure eradication of the infection.

[A psoas abscess in a patient with Crohn's disease]

We report a case of Crohn's disease diagnosed 13 years ago, complicated by a psoas abscess. The main symptoms were flexion deformity of the hip, pain and fever. Diagnosis was made by CT-scan. Surgical and CT-guided percutaneous drainage was ineffective and the abscess relapsed. Surgical resection of the affected bowel with abscess drainage, provided patient's healing.