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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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Fuchita Y, Toyoshima H, Ishiguro C, Tanaka H. Successful treatment of a unique case of solitary primary iliopsoas abscess caused by Streptococcus dysgalactiae subspecies equisimilis: A case report. Medicine (Baltimore) 2024; 103:e37602. [PMID: 38552086 PMCID: PMC10977565 DOI: 10.1097/md.0000000000037602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/23/2024] [Indexed: 04/02/2024] Open
Abstract
RATIONALE Iliopsoas abscess, mainly caused by Staphylococcus aureus, occurs via the bloodstream or spread from adjacent infected organs. Although a few cases regarding primary iliopsoas abscess caused by Streptococcus dysgalactiae subspecies equisimilis (SDSE) with accompanying disseminated foci have been reported to date, there has been no case report on solitary primary iliopsoas abscess caused by SDSE. PATIENT CONCERNS An 85-year-old Japanese woman presented with worsening right hip pain and fever after an exercise. Hip computed tomography revealed a right iliopsoas abscess (iliac fossa abscess), and intravenous cefazolin was started as a treatment based on the creatinine clearance level on admission. DIAGNOSES Blood cultures were positive for β-hemolytic Lancefield group G gram-positive cocci arranged in long chains, which were identified as SDSE by matrix-assisted laser desorption/ionization. No other disseminated foci were found upon performing whole computed tomography and transthoracic echocardiography. The patient was diagnosed with an SDSE solitary iliopsoas abscess. INTERVENTIONS The antimicrobial was appropriately switched to intravenous ampicillin on day 2, with the dosage adjusted to 2 g every 6 hours based on the preadmission creatinine clearance, followed by oral amoxicillin (1500 mg, daily). OUTCOMES The abscess disappeared without drainage on day 39, and the patient remained disease-free without recurrence or sequelae during a 6-month follow-up period. LESSONS SDSE can cause a solitary primary iliopsoas abscess, which can be successfully treated with an appropriate dose of antimicrobials without draining the abscess.
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Affiliation(s)
- Yuichiro Fuchita
- Department of Pharmacy, Japanese Red Cross Ise Hospital, Ise, Japan
| | - Hirokazu Toyoshima
- Department of Infectious Diseases, Japanese Red Cross Ise Hospital, Ise, Japan
- Infection Prevention and Control Office, Japanese Red Cross Ise Hospital, Ise, Japan
| | - Chiaki Ishiguro
- Infection Prevention and Control Office, Japanese Red Cross Ise Hospital, Ise, Japan
- Department of Medical Technology, Japanese Red Cross Ise Hospital, Ise, Japan
| | - Hiroyuki Tanaka
- Department of Infectious Diseases, Japanese Red Cross Ise Hospital, Ise, Japan
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Cools J, Ghijselings S, Ruythooren F, Jentjens S, Noppe N, Metsemakers WJ, Vles G. Advanced imaging shows extra-articular abscesses in two out of three adult patients with septic arthritis of the native hip joint. J Bone Jt Infect 2024; 9:27-35. [PMID: 38601001 PMCID: PMC11002917 DOI: 10.5194/jbji-9-27-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/07/2023] [Indexed: 04/12/2024] Open
Abstract
Background: Septic arthritis (SA) of the native adult hip is a rare orthopaedic emergency requiring prompt diagnosis and treatment. As clinical presentation and laboratory findings are frequently atypical, advanced imaging is often requested. This retrospective study aimed to investigate the prevalence and pattern of extra-articular infectious manifestations and their implications for pre-operative advanced imaging in patients with proven SA of the native hip joint. Methods: Out of 41 patients treated surgically for SA of the native hip during a 16-year period at our tertiary referral hospital, 25 received advanced imaging (computed tomography (CT), magnetic resonance imaging (MRI), or fluorodeoxyglucose positron emission tomography (FDG PET-CT)) prior to initial intervention. For each investigation, a specific set of variables was systematically interpreted, and the most suitable surgical approach was determined. The prognostic value was evaluated by comparing specific outcome measures and the extent of extra-articular involvement. Results: It was found that 32 % of patients had an abscess in one anatomical region, 32 % of patients had abscesses in multiple anatomical regions, and only 36 % of patients had no substantial abscess. Gluteal abscesses were especially common in patients with SA due to contiguous spread. Abscesses in the iliopsoas region were more common in patients with SA due to hematogenous seeding. A combination of several different surgical approaches was deemed necessary to adequately deal with the various presentations. No significant prognostic factors could be identified. Conclusion: We recommend performing advanced imaging in patients with suspected or proven septic arthritis of the native hip joint, as extra-articular abscesses are present in 64 % and might require varying anatomical approaches.
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Affiliation(s)
- Jordi Cools
- Department of Orthopaedic Surgery, University Hospitals Leuven – Gasthuisberg, Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, Belgium
| | - Stijn Ghijselings
- Department of Orthopaedic Surgery, University Hospitals Leuven – Gasthuisberg, Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, Belgium
| | - Fred Ruythooren
- Department of Orthopaedic Surgery, University Hospitals Leuven – Gasthuisberg, Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, Belgium
| | - Sander Jentjens
- Department of Nuclear Medicine, University Hospitals Leuven – Gasthuisberg, Leuven, Belgium
| | - Nathalie Noppe
- Department of Radiology, University Hospitals Leuven – Gasthuisberg, Leuven, Belgium
| | - Willem-Jan Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven – Gasthuisberg, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Georges Vles
- Department of Orthopaedic Surgery, University Hospitals Leuven – Gasthuisberg, Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, Belgium
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Ohyama S, Inoue M, Toshi N, Okuyama K, Tokeshi S, Suzuki N, Shiga Y, Inage K, Yawara E, Orita S, Ohtori S. Retroperitoneal Continuous Local Antibiotic Perfusion for Refractory Pyogenic Vertebral Osteomyelitis: A Case Report. Cureus 2023; 15:e50636. [PMID: 38226091 PMCID: PMC10789547 DOI: 10.7759/cureus.50636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/17/2024] Open
Abstract
Pyogenic vertebral osteomyelitis (PVO) is a prevalent infection in the elderly, frequently complicated by iliopsoas and epidural abscesses. Traditional treatments are often ineffective for refractory cases. In this report, a 76-year-old man with PVO, iliopsoas, and epidural abscess was unresponsive to antibiotics, presenting with severe lower back pain and functional impairments. A two-stage surgical intervention was implemented: anterior debridement, autogenous bone graft fixation, and novel application of retroperitoneal continuous local antibiotic perfusion (CLAP), followed by posterior fixation. A contrast test verified correct CLAP perfusion into the iliopsoas abscess and intervertebral disc space. Substantial improvements were noted postoperatively, including a marked reduction in pain, inflammation, and the size of both abscesses. In conclusion, this case demonstrates the feasibility and effectiveness of retroperitoneal CLAP in treating refractory PVO, offering a potential innovative solution for cases resistant to conventional therapies.
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Affiliation(s)
- Shuhei Ohyama
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Masahiro Inoue
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Noriyasu Toshi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Kohei Okuyama
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Soichiro Tokeshi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Noritaka Suzuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Yasuhiro Shiga
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Kazuhide Inage
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Eguchi Yawara
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
- Department of Orthopedic Surgery, Center for Frontier Medical Engineering, Chiba University, Chiba, JPN
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
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Lee YC, Li JJ, Hsiao CH, Yen CC. Clinical Characteristics and In-Hospital Outcomes in Patients with Iliopsoas Abscess: A Multicenter Study. J Clin Med 2023; 12:jcm12082760. [PMID: 37109097 PMCID: PMC10143164 DOI: 10.3390/jcm12082760] [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: 02/25/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
(1) Background: Iliopsoas abscess (IPA) is usually overlooked due to its nonspecific symptoms and signs. The resulting delayed diagnosis and treatment can increase morbidity and mortality. The purpose of the present study was to identify the risk factors for the unfavorable outcomes associated with IPA. (2) Methods: We included patients who presented to the emergency department and were diagnosed with IPA. The primary outcome was in-hospital mortality. Variables were compared, and the associated factors were examined with Cox proportional hazards model. (3) Results: Of the 176 patients enrolled, IPA was of primary origin in 50 patients (28.4%) and of secondary origin in 126 (71.6%). Skeletal origin was the most common source of secondary IPA (n = 92, 52.3%). The most common pathogens were Gram-positive cocci. Eighty-eight (50%) patients underwent percutaneous drainage, 32 (18.2%) patients underwent surgical debridement, and 56 (31.8%) patients received antibiotics. Multivariate analyses indicated that age > 65 (year) (HR = 5.12; CI 1.03-25.53; p = 0.046), congestive heart failure (HR = 5.13; CI 1.29-20.45; p = 0.021), and platelet < 150 (103/μL) (HR = 9.26; CI 2.59-33.09; p = 0.001) were significant independent predictors of in-hospital mortality in Model A, while the predictors in Model B included age > 65 (year) (HR = 5.12; CI 1.03-25.53; p = 0.046) and septic shock (HR = 61.90; CI 7.37-519.46; p < 0.001). (4) Conclusions: IPA is a medical emergency. Our study reported that patients with advanced age, congestive heart failure, thrombocytopenia, or septic shock had a significantly higher risk of mortality, and the recognition of the associated factors may aid in risk stratification and the determination of the optimal treatment plan for IPA patients.
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Affiliation(s)
- Yi-Chih Lee
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
| | - Jhih-Jin Li
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
| | - Chien-Han Hsiao
- Department of Linguistics, Indiana University, Bloomington, IN 47405, USA
| | - Chieh-Ching Yen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
- Department of Emergency Medicine, Jen-Ai Hospital Dali Branch, Taichung 412224, Taiwan
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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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Tiong J, Grant K, Gray A. A rare case of iliopsoas abscess caused by a retained shrapnel from a blast injury. BMJ Case Rep 2021; 14:e247100. [PMID: 34772686 PMCID: PMC8593738 DOI: 10.1136/bcr-2021-247100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 11/03/2022] Open
Abstract
Iliopsoas abscesses (IPA) are uncommon, with an associated mortality rate of up to 20%. We describe the case of a 55-year-old man war veteran who presented with an unusual cause of IPA secondary to retained foreign body (FB). His initial trauma 30 years before was a result of a blast injury with shrapnel penetration suffered after inadvertently driving over a landmine as an ambulance driver in a conflict region. A CT scan was performed, revealing a 13 mmx8 mm radio-opaque FB within the right psoas at the level of the fifth lumbar vertebra with a surrounding collection. Subsequent open surgical exploration removed two gravel fragments. Given the knowledge of a traumatic blast injury with retained FB and repeated episodes of sepsis, surgical exploration is warranted. To our knowledge, this is the first case of recurrent IPA secondary to a retained FB from a historical trauma.
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Affiliation(s)
- Jonathan Tiong
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh, Edinburgh, UK
- Department of General Surgery, Monash Health, Clayton, Victoria, Australia
| | - Katherine Grant
- Department of General Surgery, Monash Health, Clayton, Victoria, Australia
| | - Andrew Gray
- Department of General Surgery, Monash Health, Clayton, Victoria, Australia
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9
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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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Prabhu RM, Koshire SR, Khandelwal RCS. A Rare Case of Psoas Abscess Secondary to Mucinous Adenocarcinoma of the Appendix: A Case Report. J Orthop Case Rep 2021; 11:1-5. [PMID: 35004364 PMCID: PMC8686507 DOI: 10.13107/jocr.2021.v11.i08.2340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Iliacus and psoas muscles are located in an extraperitoneal location forming the iliopsoas compartment. Iliopsoas abscess is a myositis involving this compartment. Pseudomyxoma peritonei is characterized by an abundant extracellular collection of mucin in the peritoneal cavity. When this collection is retroperitoneal, it is termed as pseudomyxoma extraperitonei. We present to you the case of a 52-year-old female with psoas abscess secondary to mucinous adenocarcinoma of the appendix, which was later diagnosed as pseudomyxoma extraperitonei. CASE PRESENTATION A 52-year-old female presented with pain in the right flank with discharging sinuses since one year. She had previously undergone two surgeries in the past 1 year for drainage of the abscess and had taken first line anti-tubercular treatment for around 6 months. She was managed in our institute by an open drainage of the abscess. The culture reports showed an infection with E. coli. The histopathology sections showed abundant pools of extracellular mucin with strips of columnar epithelium which indicated the pathology to be a mucinous adenocarcinoma. A contrast-enhanced computed tomography scan of the abdomen and pelvis showed a ruptured appendix mucocele and a collection in the right psoas muscle showing fistulous communication with the cecum and extending to the suture site in the right flank. Anti-tubercular treatment was stopped and an oncology opinion was taken. The patient was managed with a palliative ileostomy. CONCLUSION It is important to keep in mind diagnostic possibilities other than tuberculosis of the spine when managing a patient with an iliopsoas abscess. These include pathologies of the gastrointestinal and genitourinary tract, which need to be diagnosed and managed early.
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Affiliation(s)
- Rudra M Prabhu
- Department of Orthopaedics, Seth G.S Medical College and KEM Hospital, Mumbai. Maharashtra. India
| | - Spandan R Koshire
- Department of Orthopaedics, Seth G.S Medical College and KEM Hospital, Mumbai. Maharashtra. India
| | - R C S Khandelwal
- Department of Orthopaedics, Seth G.S Medical College and KEM Hospital, Mumbai. Maharashtra. India
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11
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Zhang N, Xiong W, Li Y, Mao Q, Xu S, Zhu J, Sun Z, Sun L. Imaging features of mycotic aortic aneurysms. Quant Imaging Med Surg 2021; 11:2861-2878. [PMID: 34079747 DOI: 10.21037/qims-20-941] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Infectious aortitis (IA) is a rare and life-threatening cardiovascular disease. Early diagnosis and timely intervention are crucial for reducing mortality associated with mycotic aortic aneurysms (MAAs); however, early diagnosis is challenging due to the nonspecific symptoms. Some cases are diagnosed at an advanced stage or after developing complications, such as rupture or aortic fistula. Current state-of-the-art imaging modalities-including computed tomography (CT), magnetic resonance imaging (MRI), and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT-can detect infected aneurysms in clinically suspicious cases. MAA features on imaging include lobulated pseudoaneurysm, indistinct irregular arterial wall, perianeurysmal gas, perianeurysmal edema, perianeurysmal soft tissue mass, aneurysmal thrombosis, and high metabolic activity with increased uptake of FDG. Enlarged lymph nodes are often found adjacent to the aneurysm, while iliopsoas abscess (IPA), spondylitis, and aortic fistulas are commonly associated complications. After surgery or endovascular repair, radiological features-including ectopic gas, peri-graft fluid, thickening of adjacent bowel, pseudoaneurysm formed at the graft anastomosis, and increased uptake of FDG-may indicate an infection of aortic graft. This article provides an overview of the clinical and imaging features of MAAs. Thus, familiarity with the imaging appearances of MAAs may assist radiologists in the diagnosis and facilitation of timely treatment.
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Affiliation(s)
- Nan Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Xiong
- Department of Respiration, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yu Li
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qinxiang Mao
- Department of Radiology, Longtan Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Shangdong Xu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Beijing, China
| | - Junming Zhu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Beijing, China
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, Australia
| | - Lizhong Sun
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Beijing, China
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12
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Retroperitoneoscopic Drainage of Psoas Abscess: A Systematic Review. Surg Laparosc Endosc Percutan Tech 2020; 31:241-246. [PMID: 33252578 DOI: 10.1097/sle.0000000000000879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/22/2020] [Indexed: 12/29/2022]
Abstract
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.
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Froiio C, Bernardi DT, Asti E, Bonavina L. Retroperitoneoscopic drainage of cryptogenic psoas abscess. BMJ Case Rep 2020; 13:e235579. [PMID: 32641307 PMCID: PMC7348476 DOI: 10.1136/bcr-2020-235579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Caterina Froiio
- Surgery, Universita degli Studi di Milano, Milano, Italy
- IRCCS Policlinico San Donato, San Donato Milanese, Lombardia, Italy
| | | | - Emanuele Asti
- Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Lombardia, Italy
| | - Luigi Bonavina
- Department of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milano, Italy
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14
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Hu SY, Hsieh MS, Chang YT, Huang CC, Tsai CA, Tsai CL, Hsu CY, Shen CH, Chang YZ. Clinical features, management, and outcome of iliopsoas abscess associated with cardiovascular disorders: a hospital-based observational case series study. BMC Musculoskelet Disord 2019; 20:474. [PMID: 31653245 PMCID: PMC6815067 DOI: 10.1186/s12891-019-2798-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 08/29/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Iliopsoas abscess (IPA) is a rare clinical entity and is difficult to diagnose due to its insidious onset and nonspecific symptoms. The association between IPA and cardiovascular disorders (CVD) has been rarely reported. Computed tomographic (CT) scan can provide a definitive diagnosis of IPA and associated foci of adjacent structures. IPA is a life-threatening condition, especially when associated with CVD. MATERIALS AND METHODS We conducted a hospital-based observational study of IPA associated with CVD. Data were collected from the electronic clinical database of Taichung Veterans General Hospital (1520-bed tertiary referral hospital in central Taiwan) between July 2007 and December 2017. The diagnosis of IPA associated with CVD was confirmed by classical findings on CT and transesophageal echocardiography with compatible clinical presentation and cultures from pus/tissue and blood. RESULTS Fifteen patients of IPA associated with CVD were studied. They included 12 males (80%) and 3 females (20%), with a mean age 63.2 ± 16.9 years (31-85 years). CVD included stent-graft/endograft infection of abdominal aortic aneurysm (AAA) (40%), primary mycotic AAA (33.3%), and infective endocarditis (26.7%). Staphylococcus aureus is the most common microorganism in pus/tissue cultures (n = 3, 37.5%) and in blood cultures (n = 6, 40%). The average length of hospital stay was 33.1 ± 20.5 days (range, 3-81 days; median, 33 days). Hospital stay lasted 42.6 ± 19.2 days in the survival group and 19.0 ± 14.1 days (P = 0.018) in the non-survival group. Incidence of patients staying in the intensive care unit (ICU) with intubation > 3 days was 33% in the survival group and 100% (P = 0.028) in the non-survival group. Intra-hospital mortality rate was 40%. Poor prognostic factors in the non-survival group were hypoalbuminemia, hyponatremia, involved disc/vertebral body and/or epidural abscess, and ICU stay with intubation > 3 days. Cumulative survival rate was 25% under conservative treatments and 66.3% under aggressive treatments (P = 0.038). CONCLUSION Due to high mortality rates, clinicians should keep a high suspicion index for IPA associated with CVD through clinical presentation, physical examination, and imaging study. Timely empiric antibiotics for common bacteria, drainage for IPA, endovascular repair, or vascular reconstruction by graft replacement or bypass with intensive care should be mandatory to shorten the hospital stay, reduce medical costs, and lower mortality rate.
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Affiliation(s)
- Sung-Yuan Hu
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd, Taichung City, 40201 Taiwan
- School of Medicine, Chung Shan Medical University, Taichung City, Taiwan
- Department of Emergency Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung City, 40705 Taiwan
- Department of Nursing, College of Health, National Taichung University of Technology and Science, Taichung City, Taiwan
- Department of Nursing, Central Taichung University of Technology and Science, Taichung City, Taiwan
- School of Medicine, National Yang-Min University, Taipei City, Taiwan
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miao-Li County, Taiwan
| | - Ming-Shun Hsieh
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miao-Li County, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Tao-Yuan Branch, No. 100, Sec. 3, Cheng-Kung Road, Taoyuan, 330 Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Yao-Tien Chang
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd, Taichung City, 40201 Taiwan
- Department of Nursing, College of Health, National Taichung University of Technology and Science, Taichung City, Taiwan
| | - Chih-Che Huang
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd, Taichung City, 40201 Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Che-An Tsai
- Division of Infectious Disease, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Chung-Lin Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Chiann-Yi Hsu
- Department of Medical Research, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Chia-Hui Shen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Yan-Zin Chang
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd, Taichung City, 40201 Taiwan
- School of Medicine, Chung Shan Medical University, Taichung City, Taiwan
- Department of Clinical Laboratory, Drug Testing Center, Chung-Shan Medical University Hospital, Taichung, Taiwan
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15
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Kawai Y, Banshodani M, Moriishi M, Sato T, Shintaku S, Masaki T, Kawanishi H. Iliopsoas Abscess in Hemodialysis Patients With End-Stage Kidney Disease. Ther Apher Dial 2019; 23:534-541. [PMID: 30864296 DOI: 10.1111/1744-9987.12801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/29/2019] [Accepted: 03/11/2019] [Indexed: 11/27/2022]
Abstract
Iliopsoas abscess in HD patients is rare. We examined nine HD patients with iliopsoas abscess (six men and five diabetes mellitus cases) treated between 2005 and 2015. Mean age and dialysis vintage at onset were 72 years and 109 months, respectively. Of the nine patients, four had lumbar orthopedic diseases, and two had all components of the classic triad of iliopsoas abscess at onset. All nine patients underwent percutaneous drainage, while seven underwent antimicrobial therapy. The most common pathogenic bacterium was methicillin-resistantStaphylococcus aureus(MRSA) (n = 5). Four patients had multilocular recurrence on the same side as the initial abscess and did not undergo CT before drainage catheter removal. Five patients died in the hospital, in which three died due to infectious diseases by MRSA. We suggest percutaneous drainage as the first-line therapy for HD patients with iliopsoas abscess and recommend combining antimicrobial therapy for MRSA, because of poor prognosis.
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Affiliation(s)
- Yusuke Kawai
- Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Masataka Banshodani
- Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Misaki Moriishi
- Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Tomoyasu Sato
- Radiology, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Sadanori Shintaku
- Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan
| | - Hideki Kawanishi
- Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
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16
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Deng Y, Zhang Y, Song L, Zhang X, Shen Z, Li Z, Zhang L, Peng A. Primary iliopsoas abscess combined with rapid development of septic shock: Three case reports. Medicine (Baltimore) 2018; 97:e13628. [PMID: 30572475 PMCID: PMC6319997 DOI: 10.1097/md.0000000000013628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
RATIONALE Primary iliopsoas abscess (IPA), an uncommon clinical entity, often has no specific clinical features, and advanced imaging techniques are often required for diagnosis. PATIENT CONCERNS We successfully treated 3 patients with primary IPA complicated by rapid development of septic shock within 2 months. DIAGNOSIS All patients were in shock at the time of admission and were diagnosed with primary IPA by history, clinical examination and imaging findings. INTERVENTIONS All patients were treated by surgical drainage and sensitive antibiotics based on culture results. OUTCOMES The patients eventually recovered and were discharged within 2 months. LESSONS An IPA may not be diagnosed in a timely manner because it has no specific symptoms or signs. Therefore, special attention must be given to patients with sudden onset of abdominal pain, hip pain, or high fever without an obvious cause, a primary IPA should be highly suspected in such patients.
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Affiliation(s)
- Yingying Deng
- Trauma Emergency Center, Department of Orthopaedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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17
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Ouellette L, Hamati M, Flannigan M, Singh M, Bush C, Jones J. Epidemiology of and risk factors for iliopsoas abscess in a large community-based study. Am J Emerg Med 2018; 37:158-159. [PMID: 29784279 DOI: 10.1016/j.ajem.2018.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/13/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
- Lindsey Ouellette
- Michigan State University College of Human Medicine, Department of Emergency Medicine, 15 Michigan St NE 736, Grand Rapids, MI 49503, United States
| | - Mary Hamati
- Michigan State University College of Human Medicine, Department of Emergency Medicine, 15 Michigan St NE 736, Grand Rapids, MI 49503, United States; Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States
| | - Matt Flannigan
- Michigan State University College of Human Medicine, Department of Emergency Medicine, 15 Michigan St NE 736, Grand Rapids, MI 49503, United States; Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States
| | - Matt Singh
- Michigan State University College of Human Medicine, Department of Emergency Medicine, 15 Michigan St NE 736, Grand Rapids, MI 49503, United States; Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States
| | - Colleen Bush
- Michigan State University College of Human Medicine, Department of Emergency Medicine, 15 Michigan St NE 736, Grand Rapids, MI 49503, United States; Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States
| | - Jeffrey Jones
- Michigan State University College of Human Medicine, Department of Emergency Medicine, 15 Michigan St NE 736, Grand Rapids, MI 49503, United States; Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States.
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18
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Rodrigues J, Iyyadurai R, Sathyendra S, Jagannati M, Prabhakar Abhilash KP, Rajan SJ. Clinical presentation, etiology, management, and outcomes of iliopsoas abscess from a tertiary care center in South India. J Family Med Prim Care 2018; 6:836-839. [PMID: 29564273 PMCID: PMC5848408 DOI: 10.4103/jfmpc.jfmpc_19_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Iliopsoas abscess (IPA) is the collection of pus in the iliopsoas compartment. The etiology of IPA is variable and depends on the geographical area and the antibiotic usage prevalence in that area. This study attempts to evaluate the etiology, clinical features, risk factors, management modalities, and outcomes in patients with IPA from a tertiary care center in South India. Materials and Methods: This was a retrospective study done in a tertiary care center in South India. Patient details were obtained from electronic medical records. Results: A total of 43 patients were enrolled in the study, the causative organism could be identified in 20 (46.5%) patients. The most common etiology was tuberculosis (TB). Most (23 [56.5%]) patients were treated conservatively, 20 (46.5%) patients were treated with percutaneous drainage (PCD), and 2 (4%) patients required surgery. Conclusion: The most common cause of IPA is TB. PCD was successful in 95% of the patients with complete resolution of symptoms.
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Affiliation(s)
- Joanne Rodrigues
- Department of Anaesthesia, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramya Iyyadurai
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sowmya Sathyendra
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Manjeera Jagannati
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Sudha Jasmine Rajan
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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19
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Ghosh S, Narang H, Goel P, Kumar P, Soneja M, Biswas A. Atypical presentation of pyogenic iliopsoas abscess in two cases. Drug Discov Ther 2018; 12:47-50. [DOI: 10.5582/ddt.2018.01000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Sudeshna Ghosh
- Department of Medicine, All India Institute of Medical Science
| | - Himanshu Narang
- Department of Medicine, All India Institute of Medical Science
| | - Pawan Goel
- Department of Medicine, All India Institute of Medical Science
| | - Prabhat Kumar
- Department of Medicine, All India Institute of Medical Science
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Science
| | - Ashutosh Biswas
- Department of Medicine, All India Institute of Medical Science
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20
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Husainy MA, Daneshi M, Fang C, Yusuf GT, Ramnarine R, Wilkins CJ, Huang D. Spondylodiscitis and Iliopsoas Abscess after Inferior Vena Cava Filter Placement. J Vasc Interv Radiol 2016; 27:1730-1732. [PMID: 27926400 DOI: 10.1016/j.jvir.2016.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- Mohammad Ali Husainy
- Department of Radiology, King's College Hospital National Health Service Trust, Denmark Hill, London SE5 9RS, United Kingdom
| | - Mohammad Daneshi
- Department of Radiology, King's College Hospital National Health Service Trust, Denmark Hill, London SE5 9RS, United Kingdom
| | - Cheng Fang
- Department of Radiology, King's College Hospital National Health Service Trust, Denmark Hill, London SE5 9RS, United Kingdom
| | - G T Yusuf
- Department of Radiology, King's College Hospital National Health Service Trust, Denmark Hill, London SE5 9RS, United Kingdom
| | - Raymond Ramnarine
- Department of Radiology, King's College Hospital National Health Service Trust, Denmark Hill, London SE5 9RS, United Kingdom
| | - C J Wilkins
- Department of Radiology, King's College Hospital National Health Service Trust, Denmark Hill, London SE5 9RS, United Kingdom
| | - Dean Huang
- Department of Radiology, King's College Hospital National Health Service Trust, Denmark Hill, London SE5 9RS, United Kingdom
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21
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Hu SY, Lee BJ, Tsai CA, Hsieh MS. Concurrent emphysematous pyelonephritis, cystitis, and iliopsoas abscess from discitis in a diabetic woman. Int J Infect Dis 2016; 51:105-106. [PMID: 27637417 DOI: 10.1016/j.ijid.2016.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 02/08/2023] Open
Affiliation(s)
- Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Nursing, College of Health, National University of Taichung Science and Technology, Taichung, Taiwan.
| | - Bor-Jen Lee
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Che-An Tsai
- Division of Infection, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Shun Hsieh
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, No. 100, Sec. 3, Cheng-Kung Road, Taoyuan 330, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan.
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22
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Mehdorn M, Petersen TO, Bartels M, Jansen-Winkeln B, Kassahun WT. Psoas abscess secondary to retroperitoneal distant metastases from squamous cell carcinoma of the cervix with thrombosis of the inferior vena cava and duodenal infiltration treated by Whipple procedure: A case report and review of the literature. BMC Surg 2016; 16:55. [PMID: 27515528 PMCID: PMC4982220 DOI: 10.1186/s12893-016-0169-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 07/31/2016] [Indexed: 02/08/2023] Open
Abstract
Background Psoas abscess is a rare clinical disease of various origins. Most common causes include hematogenous spread of bacteria from a different primary source, spondylodiscitis or perforated intestinal organs. But rarely some abscesses are related to malignant metastatic disease. Case presentation In this case report we present the case of a patient with known squamous cell carcinoma of the cervix treated with radio-chemotherapy three years prior. She now presented with a psoas abscess and subsequent complete inferior vena cava thrombosis, as well as duodenal and vertebral infiltration. The abscess was drained over a prolonged period of time and later was found to be a complication caused by metastases of the cervical carcinoma. Due to the massive extent of the metastases a Whipple procedure was performed to successfully control the local progress of the metastasis. Conclusion As psoas abscess is an unspecific disease which presents with non-specific symptoms adequate therapy may be delayed due to lack of early diagnostic results. This case report highlights the difficulties of managing a malignant abscess and demonstrates some diagnostic pitfalls that might be encountered. It stresses the necessity of adequate diagnostics to initiate successful therapy. Reports on psoas abscesses that are related to cervix carcinoma are scarce, probably due to the rarity of this event, and are limited to very few case reports. We are the first to report a case in which an extensive and complex abdominal procedure was needed for local control to improve quality of life.
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Affiliation(s)
- Matthias Mehdorn
- Department of Surgery II, Faculty of Medicine, Clinic for Visceral, Transplantation, Thoracic and Vascular Surgery, OKL, University of Leipzig, Liebig Strasse 20, Leipzig, 04103, Germany
| | - Tim-Ole Petersen
- Department of Radiology, University of Leipzig, Liebig Strasse 20, Leipzig, 04103, Germany
| | - Michael Bartels
- Department of Surgery II, Faculty of Medicine, Clinic for Visceral, Transplantation, Thoracic and Vascular Surgery, OKL, University of Leipzig, Liebig Strasse 20, Leipzig, 04103, Germany
| | - Boris Jansen-Winkeln
- Department of Surgery II, Faculty of Medicine, Clinic for Visceral, Transplantation, Thoracic and Vascular Surgery, OKL, University of Leipzig, Liebig Strasse 20, Leipzig, 04103, Germany
| | - Woubet Tefera Kassahun
- Department of Surgery II, Faculty of Medicine, Clinic for Visceral, Transplantation, Thoracic and Vascular Surgery, OKL, University of Leipzig, Liebig Strasse 20, Leipzig, 04103, Germany.
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23
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Bakri FG, Hadidy AM, Hadidi F, Ryalat N, Saket L, Shurbasi N, Melhem J. Bilateral primary psoas abscesses due to methicillin-resistant Staphylococcus aureus in a neutropenic patient: a case report. J Med Case Rep 2016; 10:12. [PMID: 26786137 PMCID: PMC4719202 DOI: 10.1186/s13256-015-0781-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 12/02/2015] [Indexed: 12/03/2022] Open
Abstract
Background Pyogenic abscess of psoas muscles is a rare condition. Psoas abscess due to methicillin-resistant Staphylococcus aureus is an emerging and rare infection and so far the related data are scarce. Case presentation We report the rare case of primary and bilateral large psoas abscesses due to methicillin-resistant Staphylococcus aureus in a 54-year-old Arab Jordanian woman with breast cancer who had neutropenia after starting chemotherapy. She was diagnosed 50 days after onset of symptoms. However, despite this delay in diagnosis and the large size of the abscesses, she had a full recovery. She was treated with antibiotics and percutaneous drainage and was doing very well at a follow up of 18 months. Conclusions Psoas abscess due to methicillin-resistant Staphylococcus aureus might have insidious presentation with extensive disease especially in immunocompromised patients. However, it can be managed effectively with percutaneous catheter drainage and appropriate antibiotic therapy.
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Affiliation(s)
- Faris G Bakri
- Department of Medicine, Division of Infectious Diseases, The University of Jordan, Jordan University Hospital, Amman, 11942, Jordan.
| | - Azmy M Hadidy
- Department of Radiology Medicine, The University of Jordan, Jordan University Hospital, Amman, Jordan.
| | - Fadi Hadidi
- Division of Orthopedic Surgery, The University of Jordan, Jordan University Hospital, Amman, Jordan.
| | - Nosaiba Ryalat
- Department of Radiology Medicine, The University of Jordan, Jordan University Hospital, Amman, Jordan.
| | - Lina Saket
- Department of Radiology Medicine, The University of Jordan, Jordan University Hospital, Amman, Jordan.
| | - Nour Shurbasi
- Department of General Surgery, The University of Jordan, Jordan University Hospital, Amman, Jordan.
| | - Jamal Melhem
- Department of General Surgery, The University of Jordan, Jordan University Hospital, Amman, Jordan.
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24
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Güzel Y, Çiftçi S, Özdemir A, Acar MA. Iliopsoas Abscess (together with Bullet) Resulting from a Firearms Injury. Case Rep Orthop 2015; 2015:634356. [PMID: 26075128 PMCID: PMC4446483 DOI: 10.1155/2015/634356] [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: 01/13/2015] [Accepted: 05/05/2015] [Indexed: 12/22/2022] Open
Abstract
Psoas abscess, which is a rarely encountered infection, is defined as the accumulation of suppurative fluid within the fascia surrounding the psoas and iliac muscles. It is categorised as being primary or secondary. Although there are reports in the literature of secondary psoas abscess from foreign bodies, to the best of our knowledge, this is the first reported case of psoas abscess developing due to a bullet, following a firearms injury. The patient was first seen in the Emergency Department following a firearms injury in the posterolateral lumbar region and as the neurovascular examination was normal, the patient was discharged after 24 hours of observation. One month later, the patient presented again to the polyclinic with a high temperature and back pain. As a result of physical examination and tests, a diagnosis was made of psoas abscess and percutaneous drainage was applied under ultrasonography guidance. The complaints improved but, 10 days later with an increase in pain and indications of infection, open abscess drainage was applied and the bullet was removed. At the 6-month follow-up examination, the patient had no complaints.
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Affiliation(s)
- Yunus Güzel
- Department of Orthopaedics and Traumatology, School of Medicine, Ordu University, Campus of Cumhuriyet, Center, 52200 Ordu, Turkey
| | - Sadettin Çiftçi
- Department of Orthopaedics and Traumatology, Selçuklu School of Medicine, Selçuk University, Campus of Alaeddin Keykubat, Selçuklu, 42075 Konya, Turkey
| | - Ali Özdemir
- Department of Orthopaedics and Traumatology, Selçuklu School of Medicine, Selçuk University, Campus of Alaeddin Keykubat, Selçuklu, 42075 Konya, Turkey
| | - Mehmet Ali Acar
- Department of Orthopaedics and Traumatology, Selçuklu School of Medicine, Selçuk University, Campus of Alaeddin Keykubat, Selçuklu, 42075 Konya, Turkey
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Suzuki K, Yamaguchi T, Iwashita Y, Yokoyama K, Fujioka M, Katayama N, Imai H. Case Series of Iliopsoas Abscesses Treated at a University Hospital in Japan: Epidemiology, Clinical Manifestations, Diagnosis and Treatment. Intern Med 2015; 54:2147-53. [PMID: 26328638 DOI: 10.2169/internalmedicine.54.4284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The incidence of iliopsoas abscesses has been increasing due to advances in diagnostic imaging techniques and the increased number of elderly individuals and immunodeficient patients with co-morbidities. Our aim was to investigate the management and treatment of iliopsoas abscesses, particularly the effectiveness of computed tomography (CT)-guided drainage in the era of interventional radiology. METHODS A retrospective analysis was performed at a university hospital between January 2009 and March 2014. Patients There were 15 patients (eight men, seven women) 50-85 years of age (average: 70 years) diagnosed with an iliopsoas abscess. RESULTS The etiology of the disease was investigated in 14 of the 15 patients, each of whom had a secondary iliopsoas abscess. The primary condition in nine of these patients (64.3%) was an orthopedic infection (spondylodiscitis); the most common symptom was fever (12 patients, 80%). Altogether, 10 patients (66.7%) had a multilocular abscess and five (33.3%) had bilateral abscesses. The most common pathogen was Staphylococcus aureus (seven patients, 50%). All 14 patients underwent drainage: 11 received CT-guided drainage, two underwent postdrainage surgery and one received ultrasonography-guided drainage. Poor drainage was overcome by inserting multiple drainage tubes (six patients) or performing transmembrane drainage with a guidewire. All but one patient survived. CONCLUSION Based on the high success rate of CT-guided drainage in this study, this technique is expected to continue to play a major role in cases requiring drainage, even in patients with bilateral or multilocular abscesses. However, this modality cannot be used in cases of gastrointestinal perforation.
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Affiliation(s)
- Kei Suzuki
- Emergency and Critical Care Center, Mie University Hospital, Japan
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Hirooka N, Edo N, Danbara H, Nishimura H, Obuchi Y, Tanaka Y. Management of primary iliopsoas abscess in an immunocompetent patient followed by streptococcal toxic shock syndrome: A case report. SAGE Open Med Case Rep 2015; 3:2050313X15575939. [PMID: 27489682 PMCID: PMC4857322 DOI: 10.1177/2050313x15575939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/11/2015] [Indexed: 11/16/2022] Open
Abstract
Objectives: Clinical diagnosis of iliopsoas abscess can be challenging, as this pathology often presents without obvious focal findings. Iliopsoas abscess should thus be a differential diagnosis for patients presenting with fever of unknown origin. Patient and methods: A 62-year-old healthy Japanese man showed primary iliopsoas abscess of Klebsiella pneumoniae complicated by shock after a complete course of treatment for streptococcal toxic shock syndrome. Successful treatment was achieved with culture-driven antibiotic selection and delayed drainage. Results: This case demonstrates the importance of identifying the causative microorganisms in iliopsoas abscess to guide therapy. The standard treatments for iliopsoas abscess are antibiotics and drainage of the abscess. Management of this case included successful antibiotic use along with delayed drainage. Conclusion: This case report advances the knowledge on the etiology of iliopsoas abscess and sheds light on the need for scientific development of a treatment strategy.
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Affiliation(s)
- Nobutaka Hirooka
- Department of General Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Naoki Edo
- Department of General Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Hisanori Danbara
- Department of General Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Hiroki Nishimura
- Department of General Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Yasuhiro Obuchi
- Department of General Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Yuji Tanaka
- Department of General Medicine, National Defense Medical College, Tokorozawa, Japan
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Normansell D, Dalawari P, Jang T. Short answer question case series: a case of total body pain. Emerg Med J 2014; 31:1027-8. [PMID: 25411399 DOI: 10.1136/emermed-2014-203806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Daniel Normansell
- Division of Emergency Medicine, St Louis University School of Medicine, St Louis, Missouri, USA
| | - Preeti Dalawari
- Division of Emergency Medicine, St Louis University School of Medicine, St Louis, Missouri, USA
| | - Timothy Jang
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
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