Retroperitoneoscopic drainage of a psoas abscess

Ultrasound-Guided Percutaneous Drainage of Iliopsoas Abscess With Septicemia in an Adolescent: A Case Report and Literature Review

Introduction

Iliopsoas abscess with septicemia in the pediatric population is rare. Early diagnosis and effective management of this emergent disorder remain challenging for clinicians.

Case Presentation

A 14-year-old girl presented with right lateral and posterior hip pain and fever for 7 days before admission. Blood culture was positive for Staphylococcus aureus. Enhanced magnetic resonance imaging revealed abscesses located in the right iliopsoas muscle and on the surface deep to the fascia of the right sacroiliac joint that were 6.8 cm × 6.2 cm × 5.7 cm and 3.7 cm × 3.5 cm × 2.1 cm, respectively. A diagnosis of right iliopsoas abscesses with septicemia was made. The patient received intravenous antibiotics, underwent ultrasound-guided percutaneous catheter drainage, and recovered uneventfully. Medical literature regarding this issue published in the English language during the last two decades was reviewed.

Discussion

Primary synchronous psoas and iliacus muscle abscesses are rare and emergent disorders in the pediatric age group. The diagnosis is generally delayed owing to the deep anatomic location and nonspecific signs and symptoms. A comprehensive medical history, meticulous physical examination, and judicious use of imaging studies could establish a timely and accurate diagnosis. Surgeons should be aware of the occurrence of multiple abscesses. Prompt and adequate antibiotic therapy accompanied by a mini-invasive approach, such as ultrasound-guided, laparoscopic, or video-retroperitoneoscopic drainage of the infectious focus, if indicated and feasible, is important to achieve a good outcome in the management of iliopsoas abscess.

Retroperitoneoscopic Drainage of Psoas Abscess: A Systematic Review

BACKGROUND

Psoas abscess is a relatively rare clinical condition that can occur worldwide, is difficult to diagnose, and has a severe clinical course. Conventional treatment ranges from antibiotic therapy alone to computed tomography (CT)-guided and/or open surgical drainage. Retroperitoneoscopic drainage represents a minimally invasive and potentially definitive therapeutic option.

MATERIALS AND METHODS

A systematic review of the literature on minimally invasive extraperitoneal access for drainage of psoas abscess was conducted through PUBMED, EMBASE, and COCHRANE databases, according to the PRISMA statement guidelines. We considered only studies in English and with a full text. The quality of all selected articles was assessed for the risk of methodological bias. Additional literature sources were used to put into context the indications and limits of retroperitoneoscopic drainage.

RESULTS

Seven papers published between 2004 and 2020, including a total of 56 patients, met the eligibility criteria and were included in the qualitative analysis. Causative agents of psoas abscess included Mycobacterium tuberculosis, Klebsiella pneumoniae, Enterobacter aerogenes, Staphylococcus aureus, and Streptococcus spp. Tuberculous abscess was more common than pyogenic abscess (92.8% vs. 7.2%). Main clinical findings were back pain (76.8%) and fever (53.6%). All patients were preoperatively evaluated by CT or magnetic resonance imaging. Only 4 patients (7.1%) had previously undergone CT-guided percutaneous drainage. Retroperitoneoscopic drainage was combined with antibiotic therapy in all cases. No Clavien-Dindo grade >3 complications occurred, and there was no 30-day postoperative mortality. The recurrence rate was 1.8% at a mean follow-up of 21 months.

CONCLUSION

Retroperitoneoscopic surgical drainage is a safe and effective approach for the treatment of psoas abscess.

Laparoscopic management for a psoas abscess caused by migrated urolithiasis

Introduction

To describe laparoscopic surgery for psoas abscess caused by migrated urolithiasis.

Case presentation

A 64‐year‐old female had renal stones in the right kidney for 5 years. She developed right back pain. Her body temperature was 37.4°C, and right costovertebral angle tenderness was detected. In blood examination, her C‐reactive protein level was elevated. Computed tomography revealed that one stone had migrated into the right psoas muscle and caused psoas abscess. Another stone was detected in the renal parenchyma. Percutaneous drainage and antibiotic treatment were performed until her symptoms and inflammation improved. However, psoas abscess recurred after removal of the drainage tube. The migrated stone was laparoscopically removed after fenestration of psoas abscess, and laparoscopic nephrolithotomy was simultaneously performed for the other stone.

Conclusion

To the best of our knowledge, this is the first case report of psoas abscess caused by migrated urolithiasis that was managed by minimally invasive surgery.

Retroperitoneoscopic drainage of cryptogenic psoas abscess

Psoas abscess is a rare and occasionally life-threatening condition. In the past, the major cause of psoas abscess was a descending infection originating from spine tuberculosis (Pott's disease). Subsequently, secondary infection from spondylodiscitis or Crohn's disease has become the prevalent aetiology. Conventional treatment ranges from antibiotic therapy alone to CT-guided and/or surgical drainage. We present the case of a 67-year-old man with a complex history, including pneumonia, sepsis and previous muscle-skeletal trauma. The patient subsequently developed a psoas abscess that was successfully treated with a minimally invasive retroperitoneoscopic approach and antibiotics. Blood cultures and pus yielded Gram-positive Streptococcus sp, and transesophageal echocardiography identified endocarditis as a possible source of sepsis. Postoperative clinical course was complicated by recurrent sepsis that required a change of antibiotic therapy. The patient was eventually discharged to rehabilitation care without further complications. The retroperitoneoscopic approach is safe and effective for the treatment of cryptogenic psoas abscess.

Primary psoas abscess caused by group A streptococcus in a child: Case report with microbiologic findings

Primary abscess of the iliopsoas muscle in children is uncommon, especially due to Streptococcus pyogenes (group A streptococcus: GAS), which causes a variety of diseases ranging from pharyngitis to invasive life-threatening infection. We present primary iliopsoas abscess in a nine-year-old boy presenting with fever, mild disturbance of consciousness, limp, and pain in the right loin. Magnetic resonance imaging and isolation of GAS from both blood and abscess samples led us to the confirmative diagnosis. The patient recovered after treatment comprising drainage and intravenous antibiotics. The CovRS system is one of the best-characterized systems with two-component signal transduction in the GAS, and mutations in covRS induce overproduction of various virulence factors that play a crucial role in invasive GAS infection. RopB, also known as a GAS regulator, influences the expression of multiple regulatory networks to coregulate virulence factor expression in GAS. In the present case, sequence analysis revealed the isolated GAS as emm type 6 with alterations in covS, whereas the covR and ropB genes were intact. The covS alterations might have influenced the virulence of the strain causing this severe GAS infection.

Retroperitoneoscopic drainage of bilateral psoas abscesses under intraoperative laparoscopic ultrasound guidance

Despite improved diagnostic modalities for psoas abscesses, the optimum management strategy is not uniform. A 67-year-old man presented with bilateral psoas abscesses secondary to L1-L2 pyogenic discitis. On contrast-enhanced CT, the largest of these abscesses measured 13 × 14 × 33 mm on the right. The patient developed sepsis caused by Klebsiella pneumonia. There were no signs of improvement after 3 weeks of systematic antibiotic administration. We performed surgical drainage of bilateral psoas abscesses by retroperitoneoscopy. Intraoperative laparoscopic ultrasound was useful to determine abscess location in the muscles prior to drainage and confirm no residual abscesses after drainage. The patient was afebrile 3 days later, and his clinical symptoms resolved. Retroperitoneoscopic drainage may represent a feasible minimally invasive therapeutic option for psoas abscess, and intraoperative laparoscopic ultrasound has the potential to increase the safety and efficacy of this surgical procedure.

Retroperitoneal abscesses in two western lowland gorillas (Gorilla gorilla gorilla)

This report describes two cases of retroperitoneal abscesses in female western lowland gorillas (Gorilla gorilla gorilla). Clinical symptoms included perivulvar discharge, lameness, hindlimb paresis, and general malaise. Retroperitoneal abscesses should be considered as part of a complete differential list in female gorillas with similar clinical signs.

Retroperitoneoscopic drainage of complicated psoas abscesses in patients with tuberculous lumbar spondylitis

PURPOSE

Nowadays, endoscopic techniques are widely used in surgical procedures. Retroperitoneoscopy has been an extremely valuable tool for a wide variety of urologic disorders, whereas, it has limited use in orthopedic procedures.

METHODS

We performed retroperitoneoscopic drainage (in combination with medical treatment) of complicated psoas abscess on 12 patients with tuberculous spondylitis. All the procedures were done under general anesthesia and in the lateral decubitus position. Psoas abscess was evacuated during procedure, and postoperatively, drainage was continued through a large silastic tube. The definitive diagnosis and the treatment were made based on the results of culture-antibiogram and PCR testing.

RESULTS

Complete clinical and radiologic remission was observed in all patients in 3-6 months. The complication was not observed in any case postoperatively.

CONCLUSIONS

Retroperitoneoscopic drainage of psoas abscesses gains advantages in terms of rapid recovery, minimal invasiveness, absence of radiation, and shorter hospital stay. This procedure can be used not only for cold abscesses but also for other pathologies of lumbar vertebral area.