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Al-Khafaji MQ, Al-Smadi MW, Al-Khafaji MQ, Aslan S, Al-Khafaji YQ, Bagossy-Blás P, Al Nasser MH, Horváth BL, Viola Á. Evaluating Imaging Techniques for Diagnosing and Drainage Guidance of Psoas Muscle Abscess: A Systematic Review. J Clin Med 2024; 13:3199. [PMID: 38892910 PMCID: PMC11173313 DOI: 10.3390/jcm13113199] [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: 04/15/2024] [Revised: 05/03/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Psoas muscle abscess (PMA) is an uncommon yet severe condition characterized by diagnostic and therapeutic challenges due to its varied etiology and nonspecific symptoms. This study aimed to evaluate the effectiveness and accuracy of various imaging techniques used in the image-guided percutaneous drainage (PD) of PMA. Methods: A systematic review was conducted following the PRISMA guidelines. We searched PubMed, Google Scholar, and Science Direct for studies published in English from 1998 onwards that reported on the use of PD in treating PMA, detailing outcomes and complications. Imaging modalities guiding PD were also examined. Results: We identified 1570 articles, selecting 39 for full review. Of these, 23 met the inclusion criteria; 19 were excluded due to unspecified PMA, absence of imaging guidance for PD, or inconclusive results. Eleven studies utilized computed tomography (CT) for PD, with six also using magnetic resonance imaging (MRI). Ten studies implemented ultrasound (US)-guided PD; variations in diagnostic imaging included combinations of US, CT, and MRI. A mixed approach using both CT and US was reported in two articles. Most studies using CT-guided PD showed complete success, while outcomes varied among those using US-guided PD. No studies employed MRI-guided PD. Conclusions: This review supports a multimodal approach for psoas abscess management, using MRI for diagnosis and CT for drainage guidance. We advocate for Cone Beam CT (CBCT)-MRI fusion techniques with navigation systems to enhance treatment precision and outcomes, particularly in complex cases with challenging abscess characteristics.
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Affiliation(s)
- Murtadha Qais Al-Khafaji
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Mohammad Walid Al-Smadi
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
| | - Mustafa Qais Al-Khafaji
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Siran Aslan
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
- Department of Neurotraumatology, Semmelweis University, 1081 Budapest, Hungary
- Doctoral School of Clinical Medicine, Semmelweis University, 1083 Budapest, Hungary
| | - Yousif Qais Al-Khafaji
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Panna Bagossy-Blás
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
| | - Mohammad Hakem Al Nasser
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Bálint László Horváth
- Department of Traumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary;
| | - Árpád Viola
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
- Department of Neurotraumatology, Semmelweis University, 1081 Budapest, Hungary
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Guerrero V, Park A, Zhou SY. A Case Report of Iliopsoas Abscess Secondary to Small Bowel Fistula. Cureus 2023; 15:e34749. [PMID: 36909091 PMCID: PMC9998165 DOI: 10.7759/cureus.34749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Iliopsoas abscesses (IPAs) are rare infections in the musculature that can be difficult to diagnose due to nonspecific presentations. These abscesses are most commonly caused by either the hematogenous spread of a separate infectious source in the body or secondary to Crohn's disease and are typically treated with antibiotic therapy and percutaneous drainage. For cases complicated by bowel disease, multiloculated psoas abscess, or gas-forming organisms, surgical drainage may be indicated. We present the case of an 81-year-old female with a history of colon cancer status post-cecum resection who presented with back pain, thigh pain, and constipation. Computerized tomography imaging showed concurrent small bowel obstruction and a right IPA extending down to the right thigh. Laparoscopic exploration revealed a small bowel fistulization to the right iliopsoas as the source of infection. Resection of the small bowel and surgical incision and drainage of the abscess were necessary for her treatment. The patient was discharged with vacuum-assisted closure of her wound after a hospital course complicated with chronic diarrhea. Bowel fistulization should be considered a potential cause of IPAs in patients with a complicated gastrointestinal history.
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Affiliation(s)
- Veronica Guerrero
- General Surgery, Northwestern Medicine McHenry Hospital, McHenry, USA
| | - Agnes Park
- General Surgery, Chicago Medical School, North Chicago, USA
| | - Steven Y Zhou
- General Surgery, Chicago Medical School, North Chicago, USA
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Fesatidou V, Petsatodis E, Kitridis D, Givissis P, Samoladas E. Minimally invasive outpatient management of iliopsoas muscle abscess in complicated spondylodiscitis. World J Orthop 2022; 13:381-387. [PMID: 35582155 PMCID: PMC9048501 DOI: 10.5312/wjo.v13.i4.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/29/2021] [Accepted: 03/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Iliopsoas muscle abscess (IPA) and spondylodiscitis are two clinical conditions often related to atypical presentation and challenging management. They are both frequently related to underlying conditions, such as immunosuppression, and in many cases they are combined. IPA can be primary due to the hematogenous spread of a microorganism to the muscle or secondary from a direct expansion of an inflammatory process, including spondylodiscitis. Computed tomography-guided percutaneous drainage has been established in the current management of this condition. AIM To present a retrospective analysis of a series of 8 immunocompromised patients suffering from spondylodiscitis complicated with IPA and treated with percutaneous computed tomography-guided drainage and drain insertion in an outpatient setting. METHODS Patient demographics, clinical presentation, underlying conditions, isolated microorganisms, antibiotic regimes used, abscess size, days until the withdrawal of the catheter, and final treatment outcomes were recorded and analyzed. RESULTS All patients presented with night back pain and local stiffness with no fever. The laboratory tests revealed elevated inflammatory markers. Radiological findings of spondylodiscitis with unilateral or bilateral IPA were present in all cases. Staphylococcus aureus was isolated in 3 patients and Mycobacterium tuberculosis in 2 patients. Negative cultures were found in the remaining 3 patients. The treatment protocol included percutaneous computed tomography-guided abscess drainage and drain insertion along with a course of targeted or empiric antibiotic therapy. All procedures were done in an outpatient setting with no need for patient hospitalization. CONCLUSION The minimally invasive outpatient management of IPA is a safe and effective approach with a high success rate and low morbidity.
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Affiliation(s)
- Vasiliki Fesatidou
- 4th Department of General Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece
| | - Evangelos Petsatodis
- Department of Interventional Radiology, Papanikolaou General Hospital of Thessaloniki, Thessaloniki 57010, Greece
| | - Dimitrios Kitridis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece
| | - Panagiotis Givissis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece
| | - Efthimios Samoladas
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece
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Al-Sadhan NA, Liebmann O, Dwyer KH. Point-of-care Ultrasound Identification of Iliopsoas Abscess in Emergency Department: A Case Report. Clin Pract Cases Emerg Med 2020; 4:404-406. [PMID: 32926697 PMCID: PMC7434260 DOI: 10.5811/cpcem.2020.5.45255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The iliopsoas muscle is a rare place for an abscess to collect. While these abscesses can have high mortality, they are often misdiagnosed. The use of point-of-care ultrasound (POCUS) can aid in earlier diagnosis. CASE REPORT A 45-year-old male presented to the emergency department (ED) with severe lower back pain. The pain radiated to both of his legs and was associated with fever, weight loss, and malaise. The differential diagnosis for this patient was broad. A POCUS was performed at the bedside and revealed bilateral iliopsoas abscesses. This finding was then confirmed by computed tomography. CONCLUSION In this case report we will discuss how to identify an iliopsoas abscess using POCUS in ED patients, and the utility of POCUS to facilitate an expedited diagnosis.
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Affiliation(s)
- Nehal A. Al-Sadhan
- King Fahad Medical City, Department of Emergency Medicine, Riyadh, Saudi Arabia
| | - Otto Liebmann
- Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Division of Emergency Ultrasound, Providence, Rhode Island
| | - Kristin H. Dwyer
- Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Division of Emergency Ultrasound, Providence, Rhode Island
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Ghazanfar H, Ali NN, Cindrich RB, Matela A. A Microbiologist's Mexico Trip Ends with Multiple Tiny Ring-Like Pelvic Abscesses. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e922221. [PMID: 32296009 PMCID: PMC7185817 DOI: 10.12659/ajcr.922221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patient: Female, 22-year-old Final Diagnosis: Iliacus muscle abscess Symptoms: Back pain • diarhea • leg weakness Medication:— Clinical Procedure: Joint aspiration Specialty: Infectious Diseases • General and Internal Medicine
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Affiliation(s)
- Haider Ghazanfar
- Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA
| | - Nisha N Ali
- Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA
| | - Richard B Cindrich
- Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA.,Division of Infectious Diseases, BronxCare Health System, Bronx, NY, USA
| | - Ajsza Matela
- Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA.,Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, NY, USA
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Atif M, Malik AT, Noordin S. Psoas abscess masquerading as a prosthetic hip infection: A case report. Int J Surg Case Rep 2017; 42:17-19. [PMID: 29202351 PMCID: PMC5723361 DOI: 10.1016/j.ijscr.2017.11.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/26/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022] Open
Abstract
Psoas muscle forms a conduit for spread of infection from upper part of body to hip joint. In the presence of prosthetic hip, psoas abscess may present as prosthetic joint infection. Treatment depends on early detection of causative organisms and their eradication.
Introduction Psoas abscess is an unusual condition and is defined as a collection of pus in the iliopsoas compartment. Due to the unique anatomy of psoas muscle it forms a conduit for spread of infection from upper part of body to hip joint in neglected cases. Case presentation A 67 year old lady presented with left groin pain for three weeks. She underwent an uncemented unipolar hemiarthoplasty eight years back. Currently, she developed fever and was unable to do any active left hip range of motion. Passive motion of the left hip was restricted to 30° flexion, no internal rotation, 5° external rotation, and 10° abduction. Lab workup showed raised serum infective markers and radiographs of pelvis were normal with no evidence of any radiolucency. Ultrasound guided aspiration of left hip joint showed E coli. Arthrotomy revealed clear fluid in hip joint but pus was drained at psoas insertion. Later on, culture reported presence of E. coli and biopsy confirmed psoas abscess. Postoperatively CT scan abdomen showed pyelonephritis. Antibiotics were given for three months. Twenty months later, she remains asymptomatic without evidence of infection with normal gait. Discussion Psoas abscess is a rare clinical entity that may mimic symptoms of a primary prosthetic hip infection. Treatment outcomes are directly related to early detection with adequate dissection of the psoas muscle up to sites of attachment and complete eradication of infection. Conclusion This case highlights importance of thorough initial clinical examination, lab workup and radiological assessment to rule out rare causes of hip joint pain.
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Affiliation(s)
- Muhammad Atif
- Section of Orthopaedic Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Azeem Tariq Malik
- Section of Orthopaedic Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan.
| | - Shahryar Noordin
- Section of Orthopaedic Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
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Gunaratne GDR, Khan RJK, Tan C, Golledge C. Bilateral prosthetic hip joint infections associated with a Psoas abscess. A Case Report. J Orthop Case Rep 2017; 6:3-6. [PMID: 28116254 PMCID: PMC5245931 DOI: 10.13107/jocr.2250-0685.472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Psoas abscess is a recognized but under-diagnosed complication of prosthetic hip joint infections. Case report: We report a case of a 68-year-old man with right and left hip arthroplasties performed 22 and 14 years ago, respectively, who presented with non-specific symptoms and was subsequently diagnosed with left psoas abscess on CT scan. Drainage of the psoas abscess was complicated by the formation of a discharging sinus connected to the left hip. He then developed an infected right thigh haematoma, which also formed a discharging sinus connecting to the right hip post-drainage. He was treated with bilateral two-stage revision total hip arthroplasties and multiple courses of prolonged antibacterial therapy. Both abscesses and hip joints cultured the same species of multi-sensitive Staphylococcus aureus. The causal link between the psoas abscess and the prosthetic hip infections is discussed, as well as the investigation and management. Conclusion: We recommend routine exploration of the iliopsoas bursa when revision of an infected total hip arthroplasty is performed to rule out intrapelvic spread of the infection [3]. There should be high index of suspicion of prosthetic hip infection in patients presenting with Psoas abscess and vice versa. A CT scan might be warranted to rule out concomitant infection in both these patients.
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Affiliation(s)
| | - Riaz J K Khan
- Department of Computer Science and Engineering, Curtin University of Technology, Perth, Australia; The University of Notre Dame, Perth, Australia; The Joint Studio, Perth, Australia
| | - Cynthia Tan
- Hollywood Private Hospital, Perth, Australia
| | - Clayton Golledge
- Department of Infectious Diseases, Sir Charles Gairdner Hospital, Perth, Australia
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Abstract
General medical conditions are an important part of the differential diagnosis in athletes presenting with pain or injury. A psoas abscess is a collection of pus in the iliopsoas muscle compartment and is a rare cause of hip, low back, or groin pain. Psoas abscesses may have significant morbidity and mortality, as 20% progress to septic shock. Presenting symptoms are generally nonspecific and the onset may be subacute. Clinical presentation may have features suggestive of other diagnoses, including septic hip arthritis, iliopsoas bursitis, and retrocecal appendicitis. Proper diagnosis and management is critical to prevent complications of septic shock and death. In this unique case, a 19-year-old Division 1 collegiate football player presented to the emergency department 4 days following injury to his right groin during football practice. He complained of severe right groin pain accompanied by fatigue, fevers, nausea, and diarrhea. He later developed septic shock with multisystem organ dysfunction, requiring advanced life support. Imaging revealed an abscess located in the right iliopsoas compartment. After proper treatment, the athlete eventually made a complete recovery, returning to collegiate football 4 months postinjury. A literature review found no described cases of psoas abscess related to athletes with acute hip flexor strain. This athlete had no known risk factors for psoas abscess. This case highlights the importance of maintaining a broad differential in an athlete presenting with pain after injury. Making the diagnosis of psoas abscess often requires a high degree of suspicion and timely acquisition of imaging studies. In this particular case, imaging was key to making a proper diagnosis and tailoring treatment not only to return him to sport but also to save his life.
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Affiliation(s)
| | - Robert J Baker
- Department of Sports Medicine, Homer Stryker M.D. School of Medicine, Western Michigan University, Kalamazoo, Michigan
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Miller ELC, Miller LFF, Carvalho JG, Marsillac A, Pires L, Babinski MA, Monteiro M. Psoas muscle abscess simulating acute appendicits: A case report. Int J Surg Case Rep 2016; 25:139-42. [PMID: 27372027 PMCID: PMC4929344 DOI: 10.1016/j.ijscr.2016.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/10/2016] [Accepted: 06/10/2016] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Psoas abscess is a rare clinical entity with vague symptomatology. We report a psoas abscess that simulated symptoms of acute appendicitis. PRESENTATION OF CASE A twenty-five year old male presented pain irradiating to the right iliac fossa and lumbar region associated with thigh flexion. Laboratorial exams revealed leukocytosis with a neutrophil shift to the left. Abdominal Ultrasound showed significant intestinal distension and a small quantity of free fluid at the right iliac fossa. Laparotomy and an appendectomy were performed. During immediate post-operative, the patient evolved with worsening of the pain and the leukocytosis, therefore, we chose to maintain his antalgic posture. An abdominal Computerized Tomography scan with contrast was solicited, revealing an increase of the iliac and psoas muscles of the right side, and multiple bacterial focuses. A retroperitoneal access was performed and 300ml of purulent secretion was drained. Afterwards, we implanted a Penrose Drain. The patient had a good post-op evolution, being discharged 7days after the drainage. DISCUSSION The psoas muscle is a flexor of the thigh. Psoas abscess is an underdiagnosed condition, its main treatment is surgery associated with antibiotic therapy. CT scan seems to be the best choice of diagnostic image exam, although some authors prefer the nuclear magnetic resonance. CONCLUSION The psoas muscle abscess is uncommon and poorly characterized in its etiology, clinical associations, and its therapeutic approach. On the other hand, acute appendicitis is the most common abdominal emergency, with a 7% death rate, and surgery is its main treatment.
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Affiliation(s)
- Eugenio L C Miller
- General Surgery Service of Municipal Hospital Moacyr Rodrigues do Carmo - Duque de Caxias, Rio de Janeiro, Brazil
| | - Luiz F F Miller
- General Surgery Service of Municipal Hospital Moacyr Rodrigues do Carmo - Duque de Caxias, Rio de Janeiro, Brazil
| | - Jorge G Carvalho
- General Surgery Service of Municipal Hospital Moacyr Rodrigues do Carmo - Duque de Caxias, Rio de Janeiro, Brazil
| | - Alexandre Marsillac
- General Surgery Service of Municipal Hospital Moacyr Rodrigues do Carmo - Duque de Caxias, Rio de Janeiro, Brazil
| | - Lucas Pires
- Morphology Department, Biomedical Institute, Fluminense Federal University - Niterói, Rio de Janeiro, Brazil
| | - Marcio A Babinski
- General Surgery Service of Municipal Hospital Moacyr Rodrigues do Carmo - Duque de Caxias, Rio de Janeiro, Brazil; Morphology Department, Biomedical Institute, Fluminense Federal University - Niterói, Rio de Janeiro, Brazil.
| | - Mauro Monteiro
- General Surgery Service of Municipal Hospital Moacyr Rodrigues do Carmo - Duque de Caxias, Rio de Janeiro, Brazil
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Cargill T, Gupta V, Thomas P. Pyogenic iliopsoas abscess: An uncommon presentation of nonspecific leg pain. J Acute Med 2014. [DOI: 10.1016/j.jacme.2013.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cacurri A, Cannata G, Trastulli S, Desiderio J, Mangia A, Adamenko O, Pressi E, Giovannelli G, Noya G, Parisi A. A rare case of perforated descending colon cancer complicated with a fistula and abscess of left iliopsoas and ipsilateral obturator muscle. Case Rep Surg 2014; 2014:128506. [PMID: 24744948 PMCID: PMC3976818 DOI: 10.1155/2014/128506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/09/2014] [Indexed: 01/03/2023] Open
Abstract
Perforation of descending colon cancer combined with iliopsoas abscess and fistula formation is a rare condition and has been reported few times. A 67-year-old man came to our first aid for an acute pain in the left iliac fossa, in the flank, and in the ipsilateral thigh. Ultrasonography and computed tomography revealed a left abdominal wall, retroperitoneal, and iliopsoas abscess that also involved the ipsilateral obturator muscle. It proceeded with an exploratory laparotomy that showed a tumor of the descending colon adhered and perforated in the retroperitoneum with abscess of the iliopsoas muscle on the left-hand side, with presence of a fistula and liver metastases. A left hemicolectomy with drainage of the broad abscess was performed. Pathologic report findings determined adenocarcinoma of the resected colon.
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Affiliation(s)
- Alban Cacurri
- Department of General and Oncologic Surgery, University of Perugia, 06157 Perugia, Italy
| | - Gaspare Cannata
- Department of General and Oncologic Surgery, University of Perugia, 06157 Perugia, Italy
| | - Stefano Trastulli
- Department of Digestive and Liver Surgery Unit, St. Maria Hospital, 05100 Terni, Italy
| | - Jacopo Desiderio
- Department of Digestive and Liver Surgery Unit, St. Maria Hospital, 05100 Terni, Italy
| | - Antongiulio Mangia
- Department of General and Oncologic Surgery, University of Perugia, 06157 Perugia, Italy
| | - Olga Adamenko
- Department of Digestive and Liver Surgery Unit, St. Maria Hospital, 05100 Terni, Italy
| | - Eleonora Pressi
- Department of Digestive and Liver Surgery Unit, St. Maria Hospital, 05100 Terni, Italy
| | - Giorgio Giovannelli
- Department of Digestive and Liver Surgery Unit, St. Maria Hospital, 05100 Terni, Italy
| | - Giuseppe Noya
- Department of General and Oncologic Surgery, University of Perugia, 06157 Perugia, Italy
| | - Amilcare Parisi
- Department of Digestive and Liver Surgery Unit, St. Maria Hospital, 05100 Terni, Italy
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Kamata T, Ochiai M, Osaki K, Fujisawa N, Kadoya Y, Yashiro M. Ultrasound-guided brachial venous cannulation as a novel venous needle site in hemodialysis patients. ACTA ACUST UNITED AC 2011. [DOI: 10.4009/jsdt.44.237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Alvi AR, Rehman ZU, G Nabi ZUR. Pyogenic psoas abscess: case series and literature review. Trop Doct 2010; 40:56-8. [DOI: 10.1258/td.2009.090212] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
From 1998 to 2008, six patients with pyogenic psoas abscesses were managed. Pain and fever were the most common presentations. Two patients had primary pyogenic abscesses and four had secondary pyogenic abscesses. The diagnoses were made either by computed tomography scans (50%) or magnetic resonance imaging and pus culture were obtained. The associated conditions included: perinepheric abscess (1); lumbar discitis (2); and infected thrombosed abdominal aortic aneurysm (1). Five patients underwent radiologically-guided percutaneous drainage and one required open surgical drainage of the abscess cavity. Optimal results were achieved in all cases except one who died of acute myocardial infarction.
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Affiliation(s)
- Abdul Rehman Alvi
- Department of Surgery, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi – 74800, Pakistan
| | - Zia Ur Rehman
- Department of Surgery, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi – 74800, Pakistan
| | - Zia Ur Rehman G Nabi
- Department of Surgery, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi – 74800, Pakistan
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Yang WC, Lin SF. Bilateral psoas abscesses post-peripheral blood stem cell transplantation. Bone Marrow Transplant 2006; 38:73-4. [PMID: 16715109 DOI: 10.1038/sj.bmt.1705396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Baier PK, Arampatzis G, Imdahl A, Hopt UT. The iliopsoas abscess: aetiology, therapy, and outcome. Langenbecks Arch Surg 2006; 391:411-7. [PMID: 16680473 DOI: 10.1007/s00423-006-0052-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Accepted: 03/02/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The treatment strategy for patients with a retroperitonally localised abscess is controversial as it remains open which fluid collections should be drained by open access or by percutaneously inserted drainage. PATIENTS Therefore, the data of 40 consecutively treated patients with an iliopsoas abscess were analysed retrospectively. RESULTS Ten patients suffered from a primary abscess and ten from a post-operative abscess; further, in 20 patients, the aetiology of the abscesses were due to Crohn's disease, neoplasia, spondylitis or other relevant concomitant diseases. Eight of 40 patients were initially treated by image-guided percutaneous drainage (PD), the other by open access drainage. Six patients died (15%), all of them had been operated; 15 (37.5%) patients had a recurrence of their abscess and needed re-operation. Factors predicting a poor outcome were age, APACHE II score, bi-lateral abscesses and a post-operative or bony cause, but the bacteriological findings did not influence the outcome. CONCLUSIONS We suggest an algorithm for treatment of iliopsoas abscesses depending on number and volume of the abscesses.
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Affiliation(s)
- P K Baier
- Department of Visceral and General Surgery, University of Freiburg, Hugstetterstasse 55, 79104, Freiburg, Germany.
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Wagner C, Sauermann R, Joukhadar C. Principles of Antibiotic Penetration into Abscess Fluid. Pharmacology 2006; 78:1-10. [PMID: 16864973 DOI: 10.1159/000094668] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although drainage is considered the gold standard in abscess treatment, abscesses of different sizes and locations have been successfully cured by means of antibiotic treatment alone. The penetration of an antibiotic into an encapsulated purulent lesion is limited and highly dependent on the degree of abscess maturation. In fact, in vivo pharmacokinetic data demonstrate that substantial antibiotic concentrations can be reached within abscesses in humans and animals, provided the choice of an appropriate agent and an optimal dosing regimen. However, the efficacy of antibiotics in pus may be hampered by various factors like low pH, protein binding and degradation by bacterial enzymes. This article provides a comprehensive review on conservative abscess treatment, presenting clinical data on success rates of antibiotic therapy. Antibiotic concentrations measured in abscesses of humans and animals are outlined, and theoretical considerations on the understanding of pharmacokinetics and efficacy of antibiotics in abscesses are discussed.
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Affiliation(s)
- Claudia Wagner
- Division of Clinical Pharmacokinetics, Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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Kumagai K, Ushiyama T, Kawasaki T, Matsusue Y. Extension of lumbar spine infection into osteoarthritic hip through psoas abscess. J Orthop Sci 2005; 10:91-4. [PMID: 15666129 DOI: 10.1007/s00776-004-0847-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Accepted: 09/14/2004] [Indexed: 10/25/2022]
Abstract
We present a case of pyogenic lumbar discitis and septic hip arthritis, accompanied by a psoas abscess and pyogenic iliopsoas bursitis, for which the correct diagnosis was delayed. The patho-mechanism was speculated to be initial hematogenous infection in the lumbar spine that spread along the psoas muscle as a psoas abscess and then extended into the hip joint via the iliopsoas bursa. For an early correct diagnosis, clinicians should be aware that the lumbar spine and hip joint regions communicate through the psoas muscle space and iliopsoas bursa, making it possible for infection to spread.
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Affiliation(s)
- Kousuke Kumagai
- Department of Orthopedic Surgery, Shiga University of Medical Science, Seta, Otsu, 520-2192, Japan
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Abstract
Iliopsoas abscess is a relatively uncommon condition that can present with vague clinical features. Its insidious onset and occult characteristics can cause diagnostic delays, resulting in high mortality and morbidity. The epidemiology, aetiology, clinical features, and management of iliopsoas abscess are discussed.
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Affiliation(s)
- I H Mallick
- University Department of Surgery, Royal Free and University College Medical School, Hampstead, London NW3 2QG, UK.
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Tez S, Dilmen G, Unsal A, Koktener A, Cimentepe E, Saglam R. Psoas abscess twenty-one years after ipsilateral nephrectomy. Int Urol Nephrol 2004; 34:311-3. [PMID: 12899219 DOI: 10.1023/a:1024475301905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report an unusual case of psoas abscess, which developed twenty-one years after ipsilateral nephrectomy and was caused by infrequent pathogen, Proteus mirabilis. It was diagnosed by computed tomography and was drained percutaneously with a nephrostomy tube guided by ultrasonography.
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Affiliation(s)
- Selda Tez
- Department of Radiology and Urology, Fatih University, School of Medicine, Ankara, Turkey
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Buttaro M, González Della Valle A, Piccaluga F. Psoas abscess associated with infected total hip arthroplasty. J Arthroplasty 2002; 17:230-4. [PMID: 11847626 DOI: 10.1054/arth.2002.28734] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A 65-year-old man with a left uncemented total hip arthroplasty performed 11 years previously was admitted with a history of progressive low back pain, left hip pain, and sepsis that had begun 6 months earlier. On physical examination, a gross, fluctuant mass was palpated in the left thigh. A computed tomography (CT) scan revealed a 6.5 x 3 cm left retrofascial psoas abscess communicating with the hip joint. The patient underwent irrigation and débridement of the hip with removal of the components. The psoas abscess was drained through the iliopsoas bursa. A residual psoas abscess was drained percutaneously under CT guidance. Cultures isolated Escherichia coli, and the patient responded to 6 months of ciprofloxacin therapy. After 1 year, the patient had no evidence of infection. Pathways of infection spread, diagnosis, and treatment of a patient with this rare association are discussed with a review of the literature.
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Affiliation(s)
- M Buttaro
- Institute of Orthopaedics Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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Greene G. 'Red Flags': essential factors in recognizing serious spinal pathology. MANUAL THERAPY 2001; 6:253-5. [PMID: 11673937 DOI: 10.1054/math.2001.0423] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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