A case of primary psoas abscess presenting as buttock abscess

A rare presentation of iliopsoas abscess - A case report

INTRODUCTION

Psoas abscesses are usually confined to the psoas compartment due to its fascial attachments. However, in rare situations, the infection can locally spread beyond the psoas sheath.

CASE PRESENTATION

A 65-year-old patient presented with; 3 weeks of lower back and right hip pain, progressive inability to walk and one week of urinary incontinence. CT abdomen showed a right psoas abscess with pneumo-retroperitoneum extending to the right gluteus muscle, posterior compartment of the upper thigh and mediastinum. Exploration in theatre showed copious amounts of pus, visible between the fascial layers and muscles of the thigh, tracking to the level of the knee and the gluteal region.

DISCUSSION

Psoas abscesses are usually confined to the psoas compartment. However, in this case, it was spread to the posterior compartment of the thigh, gluteal region and pelvis with fascial necrosis and pus. Due to the extensive nature of the disease and the patient's clinical deterioration, he underwent open drainage of the psoas abscess, exploration and debridement of the posterior compartment of thigh and gluteal region with a good outcome.

CONCLUSION

Psoas abscesses can penetrate the psoas sheath to cause extra pelvic extension. A high index of suspicion and early imaging, if necessary, should be arranged if in doubt. Depending on the clinical severity, patients may need to be managed with open drainage and debridement than conventional CT-guided drainage.

Iliopsoas Abscess Presenting With Sacral Fracture and Gluteal Abscess: A Clinical Conundrum

Abscess of the iliopsoas muscle is a rare condition that requires a high degree of clinical suspicion for diagnosis. High mortality rates highlight the need for prompt recognition. We report the case of a 26-year-old man, with a history of intravenous drug use, who was referred from an outside facility with sacral fracture and gluteal abscess. Sacral trauma occurred 3 weeks before presentation, with progressive worsening of buttock pain. The patient was treated with irrigation and débridement of the gluteal abscess. Follow-up MRI revealed a communicating iliopsoas abscess that initially had been undiagnosed. After a prolonged hospital stay requiring additional irrigation and débridement procedures, the patient was discharged in a stable condition. Five-month follow-up has demonstrated no evidence of recurrence of infection. To our knowledge, this is the first reported case of Staphylococcus aureus gluteal abscess with pelvic extension into the iliopsoas secondary to sacral trauma and intravenous drug use.

Pelvic primary staphylococcal infection presenting as a thigh abscess

Intra-abdominal disease can present as an extra-abdominal abscess and can follow several routes, including the greater sciatic foramen, obturator foramen, femoral canal, pelvic outlet, and inguinal canal. Nerves and vessels can also serve as a route out of the abdomen. The psoas muscle extends from the twelfth thoracic and fifth lower lumbar vertebrae to the lesser trochanter of the femur, which means that disease in this muscle group can migrate along the muscle, out of the abdomen, and present as a thigh abscess. We present a case of a primary pelvic staphylococcal infection presenting as a thigh abscess. The patient was a 60-year-old man who presented with left posterior thigh pain and fever. Physical examination revealed a diffusely swollen left thigh with overlying erythematous, shiny, and tense skin. X-rays revealed no significant soft tissue lesions, ultrasound was suggestive of an inflammatory process, and MRI showed inflammatory changes along the left hemipelvis and thigh involving the iliacus muscle group, left gluteal region, and obturator internus muscle. The abscess was drained passively via two incisions in the posterior left thigh, releasing large amounts of purulent discharge. Subsequent bacterial culture revealed profuse growth of Staphylococcus aureus. The patient recovered uneventfully except for a moderate fever on the third postoperative day.