A Pain in the Psoas

Catheter-Directed Retrieval of an Infected Fragment in a Vietnam War Veteran

Background

Shrapnel injuries are commonly encountered in war zones. The severity of these injuries depends on the initial damage and both the anatomical and immune response at the time of injury or at more remote times in the case of reactivation.

Case Presentation

A veteran sustained a shrapnel injury to his left lower abdomen while serving in the Vietnam War. Nearly 50 years later, the patient presented with a recurrent retroperitoneal abscess associated with a residual fragment. In cooperation between interventional radiology and surgery, traditional endovascular techniques and devices were used to relocate an extravascular, secondarily infected fragment to an area more suitable for a minor surgical approach in the left inguinal region. Subsequent surgical excision and removal required only a superficial incision as opposed to a large retroperitoneal dissection, minimizing recovery time and allowing quick and full healing of the patient.

Conclusions

This case demonstrates a multidisciplinary approach to transforming an otherwise large retroperitoneal dissection to a minimally invasive and technically efficient abscess drainage and foreign body retrieval.

Iliopsoas Bursitis Managed with Endoscopic Bursectomy and Lesser Trochanter Decompression: A Case Report

CASE

A 32-year-old woman presented with worsening right anterior hip pain, reduced hip flexion strength, and passive range of motion during hip flexion. Magnetic resonance imaging of the hip demonstrated a prominent lesser trochanter and localized fluid signal intensity at the iliopsoas bursa. The patient underwent endoscopic iliopsoas bursectomy and lesser trochanterplasty, reporting improvement in all clinical outcome scores at 1-year follow-up.

CONCLUSION

Lesser trochanter morphology should be evaluated in patients presenting with iliopsoas bursitis. In patients failing to respond to conservative management, endoscopic iliopsoas bursectomy and lesser trochanterplasty may address pain and functional limitations.

Development of an Iliacus Muscle Abscess after School Exercise in a 17-Year-Old Female Student

Primary psoas abscess is due largely to hematogenous or lymphatic spread under immunocompromised conditions, whereas secondary psoas abscess is due largely to direct spread from adjacent infected structures. Trauma or hematoma within the muscle may predispose to the development of a primary abscess, especially if infection is present prior to injury, despite the absence of previous signs or symptoms of infection. This report describes a 17-year-old female high school student who developed an abscess within her iliacus muscle due to methicillin-susceptible <i>Staphylococcus aureus</i> after running 3 km on a hill as a school exercise. She was positive for antinuclear antibody and had had atopic dermatitis, suggesting that these factors, as well as exercise-related minor trauma or hematoma within the muscle, may have predisposed to abscess formation. She was treated with appropriate antibiotics and surgical drainage, resulting in recovery after 4 weeks.