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Nohmi S, Ikenaga S, Itaya A, Suzuki K, Yonaiyama S, Ogawa T. A large iliopsoas abscess due to colon cancer complicated by bowel obstruction: A case report. Int J Surg Case Rep 2024; 117:109449. [PMID: 38452639 PMCID: PMC10926289 DOI: 10.1016/j.ijscr.2024.109449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Iliopsoas abscesses (IPAs) associated with bowel obstruction due to colon cancer are rare, and there is no consensus regarding treatment strategies. PRESENTATION OF CASE A 63-year-old man presented with swelling and pain in the right iliac region. Imaging studies revealed an IPA expanding from the psoas major muscle and retroperitoneal space subcutaneously around the right ilium. After percutaneous drainage, the patient developed bowel obstruction secondary to colon cancer. Hemicolectomy and preventive ileostomy were performed at the gastrointestinal surgery department, and chemotherapy was administered at the medical oncology department after ileostomy closure. Three months later, local recurrence was confirmed in the right iliac region, and the recurrent lesion, including the ilium, was widely resected. One and a half years after the reoperation, there was no recurrence. DISCUSSION An IPA due to colorectal cancer without obvious perforation can also occur, and the treatment of IPAs depends on their size, location, shape, and presence of gas. Minimally invasive and staged treatment is preferable for IPAs due to colorectal cancer because the surgical mortality rate for colorectal cancer with local abscesses is high. CONCLUSION Colorectal cancer should be considered as a cause of IPAs. Treatment of IPAs caused by colon cancer should be performed in a less invasive manner after considering their size, location, shape, and the presence of gas. Cooperation between gastrointestinal surgeons and oncologists is essential for managing patients with an IPA due to colon cancer complicated by bowel obstruction.
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Affiliation(s)
- Shuya Nohmi
- Department of Orthopaedic Surgery, Misawa City Hospital, 164-65 Horiguchi, Misawa, Misawa-shi, Aomori 033-0022, Japan.
| | - Shojirokazunori Ikenaga
- Department of Surgery, Misawa City Hospital, 164-65 Horiguchi, Misawa, Misawa-shi, Aomori 033-0022, Japan
| | - Akiko Itaya
- Department of Surgery, Misawa City Hospital, 164-65 Horiguchi, Misawa, Misawa-shi, Aomori 033-0022, Japan
| | - Kazuhiro Suzuki
- Department of Medical Oncology, Misawa City Hospital, 164-65 Horiguchi, Misawa, Misawa-shi, Aomori 033-0022, Japan
| | - Shinnosuke Yonaiyama
- Department of Surgery, Hachinohe City Hospital, 3-1-1 Tamukai, Hachinohe-shi, Aomori 031-8555, Japan
| | - Taro Ogawa
- Department of Orthopaedic Surgery, Misawa City Hospital, 164-65 Horiguchi, Misawa, Misawa-shi, Aomori 033-0022, Japan
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Shoji H, Ohashi M, Yajiri Y, Minato K, Yahata M, Wakasugi M, Sawakami K, Watanabe K. Indication for drainage for a hematogenous iliopsoas abscess: Analysis of patients initially treated without drainage. J Orthop Sci 2021; 26:1130-1134. [PMID: 33317896 DOI: 10.1016/j.jos.2020.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/07/2020] [Accepted: 10/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study aimed to determine the indications for drainage in extended haematogenous iliopsoas abscesses (IPAs), which include both primary and vertebral osteomyelitis-related IPAs. METHODS Sixty-three IPA patients who were initially treated with only antibiotics and no drainage were enrolled. The success (S) group included patients who were cured without drainage, while the failure (F) group included those who required open or percutaneous drainage or died. RESULTS Compared with patients in the S group, patients in the F group (n = 15) had a higher incidence of end-stage renal disease on hemodialysis, compromised immunity, vertebral osteomyelitis of the cervicothoracic spine, other musculoskeletal infections, and multilocular abscesses. The IPAs in the F group had larger transverse and longitudinal diameters. In receiver operating characteristic curve analyses for the diameter of IPAs, the most valuable cut-off points predicting the F group were a longitudinal diameter of 5.0 cm (sensitivity, 1.0; specificity, 0.67) and a transverse diameter of 2.3 cm (sensitivity, 0.73; specificity, 0.73). A combination of both diameter cut-offs had high specificity (sensitivity, 0.73; specificity, 0.90). CONCLUSIONS Drainage should be applied in case of a larger abscess with transverse diameter ≥ 2.3 cm and longitudinal diameter ≥ 5.0 cm. Conversely, IPAs with longitudinal diameter <5 cm do not require drainage. Haemodialysis, compromised immunity, vertebral osteomyelitis of the cervicothoracic spine, and musculoskeletal infections are risk factors of conservative treatment failure.
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Affiliation(s)
- Hirokazu Shoji
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata city, Japan; Department of Orthopedic Surgery, Niigata City General Hospital, Niigata city, Japan
| | - Masayuki Ohashi
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata city, Japan.
| | - Yoichi Yajiri
- Department of Orthopedic Surgery, Nagaoka Chuo General Hospital, Nagaoka city, Japan
| | - Keitaro Minato
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata city, Japan; Department of Orthopedic Surgery, Niigata City General Hospital, Niigata city, Japan
| | - Mio Yahata
- Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Joetsu city, Japan
| | - Masashi Wakasugi
- Spine Center, Department of Orthopedic Surgery, Niigata Central Hospital, Niigata city, Japan
| | - Kimihiko Sawakami
- Department of Orthopedic Surgery, Niigata City General Hospital, Niigata city, Japan
| | - Kei Watanabe
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata city, Japan
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Lambrechts MJ, Wiegers NW, Ituarte F, Shen FH, Nourbakhsh A. Safe zone for irrigation and debridement of psoas abscess through a dorsal spinal approach. Surg Radiol Anat 2018; 40:1217-1221. [PMID: 29978329 DOI: 10.1007/s00276-018-2063-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/28/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE This cadaver study was initiated to identify safe zones for psoas abscess debridement using a dorsal spinal approach. METHODS Twenty total specimens were dissected and lumbar transverse process (TP) and psoas muscles were identified. The distance from the lateral psoas muscle to the transverse process tip was measured. The lumbar plexus was dissected from the psoas and the distance from the TP to the lateral border of the lumbar plexus was measured. The area between the lateral edge of the psoas and lumbar plexus at each lumbar level was considered a safe zone of approach for entry into the psoas muscle for abscess debridement. RESULTS The most lateral portion of the lumbar plexus was 9.3 mm medial to the superior tip of the L1 TP and 9.2 mm medial to the inferior tip at L1, it was 11.8 and 11.7 mm medial at L2, 10.5 and 9.8 mm medial at L3, 6.6 and 6.2 mm medial at L4, and 1.0 and 0.9 mm medial at L5. The distances from the TP tip to the lateral edge of the psoas muscle were 5.7 and 5.5 mm medial to the superior and inferior tip of the TP at L1, 5.1 and 4.7 mm medial at L2, 2.5 and 1.8 mm medial at L3, 0.4 and 0 mm medial at L4 and 3.7 and 3.8 mm lateral at L5. CONCLUSIONS This study provides landmarks to avoid the critical structures in the lumbar spine.
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Affiliation(s)
- Mark J Lambrechts
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Nicholas W Wiegers
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Felipe Ituarte
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Francis H Shen
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Ali Nourbakhsh
- Spine Surgery Division, Well Star Atlanta Medical Center, 303 Parkway Dr. NE, Atlanta, GA, 30312, USA.
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Kajiwara K, Yamagami T, Ishikawa M, Yoshimatsu R, Baba Y, Nakamura Y, Fukumoto W, Awai K. CT fluoroscopy-guided percutaneous drainage: comparison of the one step and the Seldinger techniques. MINIM INVASIV THER 2016; 26:162-167. [DOI: 10.1080/13645706.2016.1261901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kenji Kajiwara
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Takuji Yamagami
- Department of Radiology, Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Masaki Ishikawa
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Rika Yoshimatsu
- Department of Radiology, Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuko Nakamura
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Wataru Fukumoto
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Kinoshita M, Takao S, Takechi K, Takeda Y, Miyamoto K, Yamanaka M, Akagawa Y, Iwamoto S, Osaki K, Tani H, Ohnishi N, Shirono R. Percutaneous drainage of psoas and iliopsoas muscle abscesses with a one-step technique under real-time computed tomography fluoroscopic guidance. THE JOURNAL OF MEDICAL INVESTIGATION 2016; 63:323-7. [PMID: 27644581 DOI: 10.2152/jmi.63.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
PURPOSE To evaluate the utility and safety of drainage catheter installation for psoas/iliopsoas muscle abscesses using a one-step technique under the guidance of real-time computed tomography (CT) fluoroscopy. MATERIALS AND METHODS Ten psoas or iliopsoas muscle abscesses in 7 patients that were treated with percutaneous drainage were included in this study. All drainage procedures were carried out using a one-step technique under real-time CT fluoroscopic guidance. RESULTS The drainage catheter insertion was performed successfully with the one-step technique in all lesions. Improvements in the patients' symptoms and blood test results were seen after the drainage procedure in all cases. In addition, postoperative CT scans demonstrated that the abscesses had reduced in size or disappeared in all but one patient, who was transferred to another institution while the drainage catheter was still in place. No major complications were seen in any case. CONCLUSION The one-step procedure is simple to perform. The percutaneous drainage of psoas or iliopsoas muscle abscesses with the one-step technique under real-time CT fluoroscopic guidance is accurate and safe. Moreover, compared with the two-step technique the one-step procedure results in a shorter drainage procedure and exposes the patient and operator to lower amounts of radiation. J. Med. Invest. 63: 323-327, August, 2016.
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CT Fluoroscopy-Guided Transsacral Intervertebral Drainage for Pyogenic Spondylodiscitis at the Lumbosacral Junction. Cardiovasc Intervent Radiol 2016; 40:125-129. [PMID: 27558115 DOI: 10.1007/s00270-016-1452-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To retrospectively describe the feasibility and efficacy of CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction with a combination of two interventional radiological techniques-CT-guided bone biopsy and abscess drainage. MATERIALS AND METHODS Three patients with pyogenic spondylodiscitis at the lumbosacral junction were enrolled in this study between July 2013 and December 2015. The procedure of CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction was as follows: the sacrum at S1 pedicle was penetrated with an 11-gauge (G) bone biopsy needle to create a path for an 8-French (F) pigtail drainage catheter. The bone biopsy needle was withdrawn, and an 18-G needle was inserted into the intervertebral space of the lumbosacral junction. Then, a 0.038-inch guidewire was inserted into the intervertebral space. Finally, the 8-F pigtail drainage catheter was inserted over the guidewire until its tip reached the intervertebral space. All patients received six-week antibiotics treatment. RESULTS Successful placement of the drainage catheter was achieved for each patient without procedural complications. The duration of drainage was 17-33 days. For two patients, specific organisms were isolated; thus, definitive medical therapy was possible. All patients responded well to the treatment. CONCLUSIONS CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction is feasible and can be effective with a combination of two interventional techniques-CT fluoroscopy-guided bone biopsy and abscess drainage.
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Hsieh MS, Huang SC, Loh EW, Tsai CA, Hung YY, Tsan YT, Huang JA, Wang LM, Hu SY. Features and treatment modality of iliopsoas abscess and its outcome: a 6-year hospital-based study. BMC Infect Dis 2013; 13:578. [PMID: 24321123 PMCID: PMC3878923 DOI: 10.1186/1471-2334-13-578] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 11/27/2013] [Indexed: 12/17/2022] Open
Abstract
Background Percutaneous drainage (PCD) and surgical intervention are two primary treatment options for iliopsoas abscess (IPA). However, there is currently no consensus on when to use PCD or surgical intervention, especially in patients with gas-forming IPA. This study compared the characteristics of patients with gas-forming and non-gas forming IPA and their mortality rates under different treatment modalities. An algorithm for selecting appropriate treatment for IPA patients is proposed based on our findings. Methods Eighty-eight IPA patients between July 2007 and February 2013 were enrolled in this retrospective study. Patients < 18 years of age or with an incomplete course of treatment were excluded. Demographic information, clinical characteristics, and outcomes of different treatment approaches were compared between gas-forming IPA and non-gas forming IPA patients. Results Among the 88 enrolled patients, 27 (31%) had gas-forming IPA and 61 (69%) had non-gas forming IPA. The overall intra-hospital mortality rate was 25%. The gas-forming IPA group had a higher intra-hospital mortality rate (12/27, 44.0%) than the non-gas forming IPA group (10/61, 16.4%) (P < 0.001). Only 2 of the 13 patients in the gas-forming IPA group initially accepting PCD had a good outcome (success rate = 15.4%). Three of the 11 IPA patients with failed initial PCD expired, and 8 of the 11 patients with failed initial PCD accepted salvage operation, of whom 5 survived. Seven of the 8 gas-forming IPA patients accepting primary surgical intervention survived (success rate = 87.5%). Only 1 of the 6 gas-forming IPA patients who accepted antibiotics alone, without PCD or surgical intervention, survived (success rate = 16.7%). In the non-gas forming IPA group, 23 of 61 patients initially accepted PCD, which was successful in 17 patients (73.9%). The success rate of PCD was much higher in the non-gas forming group than in the gas-forming group (P <0.01). Conclusions Based on the high failure rate of PCD and the high success rate of surgical intervention in our samples, we recommend early surgical intervention with appropriate antibiotic treatment for the patients with gas-forming IPA. Either PCD or primary surgical intervention is a suitable treatment for patients with non-gas forming IPA.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
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