1
|
Schröder C, Calite E, Böckenhoff P, Büttner T, Stein J, Gembruch U, Strizek B. Psoas abscess in pregnancy: a review of the literature and suggestion of minimally invasive treatment options. Arch Gynecol Obstet 2024; 309:987-992. [PMID: 36840770 PMCID: PMC10867082 DOI: 10.1007/s00404-023-06970-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/08/2023] [Indexed: 02/26/2023]
Abstract
AIM Less than a dozen cases of psoas abscesses in pregnancy have been described in the literature. We reviewed the literature when treating a patient with a psoas abscess after ipsilateral double J-ureteral stent placement (in the following: "double J-stent") due to infected hydronephrosis. METHODS In January 2022, this review was searched using the Pubmed/MEDLINE database and the mesh terms "Psoas Abscess" AND "Pregnancy". Studies were included in any language and of all years, describing a psoas abscess during pregnancy. When patients did not have a psoas abscess, the abscess occurred after pregnancy, or when there was no full text available, the article was excluded. MAIN RESULTS Ten case reports about patients with psoas abscesses during pregnancy were included. The classical symptomatic triad of psoas muscle abscess included lower back pain, limping and persistent fever with daily spikes. However, in most cases, not all three symptoms can be found. Especially, fever is absent in more than half of the patients. Psoas abscesses are described between 13 and 39 weeks of gestation. Primary psoas abscesses with haematogenous spread are more common during pregnancy than secondary with spread per continuitatem. In the literature, the main reasons for psoas abscess are spinal tuberculosis, drug abuse or underlying diseases such as Crohn's disease. It is not uncommon for the definite cause to be unclear. Regarding the patient's symptoms, pyelonephritis is often considered a possible aetiology. In general, the main treatment options include antibiotic treatment and abscess drainage. There is no higher caesarean section rate, and no negative outcome for the foetus has been described. CASE PRESENTATION In our patient, a 38-year-old obese Caucasian woman, who had received a left double J-stent for infected hydronephrosis at 15 weeks of gestation, we successfully treated a psoas abscess of 20 × 10 cm with a sonographically assisted abscess drainage and antibiotics. The further course of pregnancy and the elective repeat caesarean section at 38 + 0 weeks of gestation were without any problems. Double J-stent placement and laser stone lithotripsy during puerperium were performed because of recurrent urolithiasis. CONCLUSIONS Although rare, psoas abscesses can occur during pregnancy, and it has often been treated surgically in the past. A psoas abscess as a complication after infected hydronephrosis and intervention during pregnancy has never been reported in the literature. Even for obese patients, minimally invasive therapy may be a treatment option that has rarely been reported in the literature.
Collapse
Affiliation(s)
- Carolin Schröder
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Elina Calite
- Prenatal Care Dr. Marquet and Bewermeyer, Muffeter Weg 37, 52074, Aachen, Germany
| | - Paul Böckenhoff
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Thomas Büttner
- Department of Urology and Paediatric Urology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Johannes Stein
- Department of Urology and Paediatric Urology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| |
Collapse
|
2
|
Asil S, Görmel S, Köksal O, Eşki S, Buğan B, Yüksel UÇ. Endovascular Therapy of Aortic Rupture Secondary to a Psoas Abscess. Turk Kardiyol Dern Ars 2023; 51:353-355. [PMID: 37450451 DOI: 10.5543/tkda.2023.63458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Secondary infection of the aorta is a sporadic and life-threatening disease. It is usually caused by infection and abscess in an adjacent structure. The most common mechanism for secondary aortic infection is a psoas abscess eroding the aortic wall, which rarely results in non-aneurysmal aortic rupture. Primary treatment is surgical aortic reconstruction, but the risk of emergency surgical treatment is high. Endovascular aortic stent-graft implantation can be lifesaving in this setting by stopping the bleeding. However, the crucial question of durability and late infections remains unanswered and warrants long-term antibiotic treatment and follow-up. In this report, we present a case of primary psoas abscess, which resulted in non-aneurysmal aortic rupture and its endovascular treatment.
Collapse
Affiliation(s)
- Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Suat Görmel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Ozan Köksal
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Selen Eşki
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Barış Buğan
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Uygar Çağdaş Yüksel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| |
Collapse
|
3
|
Nishi S, Fukuoka T, Iseki Y, Shibutani M, Toyokawa T, Tanaka H, Lee S, Maeda K. [A Case Report of Psoas Abscess Formation Caused by Mucinous Cystadenocarcinoma]. Gan To Kagaku Ryoho 2022; 49:897-899. [PMID: 36046978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We report a rare case of psoas abscess formation caused by mucinous cystadenocarcinoma. A 65-year-old women was admitted to our hospital for treatment for iliopsoas abscess. She presented with standing difficulty and her laboratory data showed an increased level of leukocytes. CT scan demonstrated an abscess formation in iliopsoas muscle. Colonoscopy showed an ulcer on her cecum. Although percutaneous drainage was performed on the first day, the abscess relapsed repeatedly. Ileocolectomy was performed on post admission day 29. Abscess drainage continued after the operation, the patient was discharged on postoperative day 34. Pathological examination revealed mucinous cystadenocarcinoma on the cecal tumor. Total 8 cycles of FOLFOX6 was performed as adjuvant chemotherapy. The patient has been survived for 20 months with no recurrence.
Collapse
Affiliation(s)
- Satoshi Nishi
- Dept. of Gastroenterological Surgery, Osaka Metropolitan University
| | | | | | | | | | | | | | | |
Collapse
|
4
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
5
|
Seretis C, Seretis F, Yahia S, Gill J, Malik A, Zayyan K. Percutaneous Retroperitoneoscopic Drainage of Complex Extraperitoneal Abscesses Using Flexible Endoscopy: Description of Technique and Perioperative Care. Chirurgia (Bucur) 2021; 115:792-797. [PMID: 33378638 DOI: 10.21614/chirurgia.115.6.792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 11/23/2022]
Abstract
The treatment of primary psoas abscesses usually is performed by a combination of prolongued antiobiotic therapy and drainage with interventional radiology techniques. However, although this combination is usually adequate for the treatment of solitary extraperitoneal collections, the presence of multi-loculated complex abscesses requires usually multiple procedures and feruently mandates open surgery. Herein, we describe an alternative tehnique of percutaneous retroperitoneoscopic drainage of multiple extensive primary psoas abscesses using flexible endoscopy, which can enable treatment these cases as one-stop proedure in a minimally invasive manner.
Collapse
|
6
|
Ibrahim FMF, El-Rady AERMA. Transverse process osteotomy for surgical drainage of primary iliopsoas abscess and secondary cases combined with spondylodiscitis. Int Orthop 2020; 45:165-171. [PMID: 32712788 DOI: 10.1007/s00264-020-04732-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
Iliopsoas abscess refers to collection of fluid in iliopsoas muscle compartment. It is well-known condition in medical history as a complication of tuberculous spine infection. Most of the cases now are due to pyogenic infection. Patient usually presents late due to delayed diagnosis. We aim to present a less invasive technique for surgical drainage of iliopsoas abscess. PATIENTS AND METHODS It is a prospective study done between 2015 and 2018. The study included 28 patients with confirmed diagnosis of iliopsoas abscess. Laboratory investigations included CBC, ESR, and C-reactive protein that were done for all patients. MRI with contrast enhancement was gold standard for diagnosis. Ten patients underwent surgical psoas abscess drainage by transverse process osteotomy via Wiltse approach without any other spine intervention. Eighteen patients had posterior spine fixation and interbody fusion together with transverse process osteotomy and abscess drainage as treatment for spondylodiscitis. The patients were followed up for clinical improvement, and functional assessment was done by Oswestry disability index. ESR and CRP were used for laboratory follow-up of infection subsidence. Follow-up of abscess size and resolution was done by pelvic-abdominal ultrasonography. RESULTS The mean maximum width of the abscesses in MRI axial views was 38.8 mm. Patients were divided into two groups. Group (1) included ten patients who underwent drainage only while group (2) included 18 patients who underwent spine fusion for treatment of spondylodiscitis. The amount of pus drained intra-operatively was of average 234 cc in group 1 and 191.6 in group 2. The drain was removed in average 58.6 hours post-operatively in group 1 with mean of 168.4 cc of drained fluid and in average of 74.3 hours for group 2 with mean of 350.5 cc of drained fluid. The ODI and inflammatory markers improved in all patients. The follow-up period was of average 26.7 months. The organism was isolated from 19 patients (5 patients were tuberculous and 14 patients were different pyogenic pathogens). No fluid recollection was observed in pelvic-abdominal ultrasound during follow-up in our series. CONCLUSION Transverse process osteotomy is a safe and effective approach for drainage of psoas abscess. It can be done alone or combined with posterior spine fusion for treatment of spondylodiscitis.
Collapse
|
7
|
Hong CH, Hong YC, Bae SH, Son MW, Won SH, Ryu A, Kim CH, Chang HJ, Kim WJ. Laparoscopic drainage as a minimally invasive treatment for a psoas abscess: A single-center case series and literature review. Medicine (Baltimore) 2020; 99:e19640. [PMID: 32243394 PMCID: PMC7440240 DOI: 10.1097/md.0000000000019640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A psoas abscess is a rare but potentially devastating condition that is associated with risks of neurological deficits, septic shock, and even death. The current first-line treatment is percutaneous catheter drainage (PCD) under imaging guidance, combined with broad-spectrum antibiotics. Surgical drainage should be considered if PCD fails or is impossible.Although many studies on PCD and open surgical drainage have appeared, the outcomes of laparoscopic drainage have rarely been reported. Thus, we laparoscopically drained the psoas abscesses of 6 patients; drainage was complete and we encountered no recurrence or complication. All patients were evaluated by plain radiography, contrast-enhanced computed tomography, and laboratory tests; all were followed-up for 1 year. Laparoscopic drainage is a good treatment option when PCD fails, affording all the advantages of open surgery (complete drainage, resection of infected tissue, and contermporaneous treatment of concomitant lesions). Also, laparoscopic drainage is minimally invasive, requires a smaller incision, and allows rapid recovery.
Collapse
Affiliation(s)
| | | | - Sang Ho Bae
- Department of Surgery, Soonchunhyang University Hospital Cheonan, Dongnam-gu, Cheonan
| | - Myoung Won Son
- Department of Surgery, Soonchunhyang University Hospital Cheonan, Dongnam-gu, Cheonan
| | - Sung Hun Won
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul
| | - Aeli Ryu
- Department of Obstetrics and Gynecology, Soonchunhyang University Hospital Cheonan, Suncheonhyang 6-gil, Dongam-gu, Cheonan, Korea
| | | | | | | |
Collapse
|
8
|
Amano K, Nakata K, Tsujie M, Shimizu K, Kawada M, Ebihara T, Yakushiji H, Tsunetoshi Y, Usui A, Nakata Y, Ikeda N, Kimura Y, Fujita J. [A Case of Laparoscopic Resection of Sigmoid Colon Cancer Complicated by an Iliopsoas Abscess Preceded by Abscess Drainage]. Gan To Kagaku Ryoho 2016; 43:1824-1826. [PMID: 28133144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
For colon cancer complicated by iliopsoas abscess, it is unclear whether surgery should be performed prior to abscess drainage. We were able to perform laparoscopic sigmoid resection safely after first draining the abscess. We believed it would be beneficial to avoid surgery in the presence of abscess and inflammation, and the minimally invasive operation was performed after improvements of the patient's general status and inflammation.
Collapse
Affiliation(s)
- Koji Amano
- Dept of Acute Care Surgery, Sakai City Medical Center
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Alif Adlan MT, Wan Mohd Rasis WAK, Mohd Ramadhan MD. Fever with intradialytic pelvic pain: a case of iliopsoas abscess complicated with Methicillin-sensitive Staphylococcus Aureus bacteraemia in an end stage renal failure patient. Med J Malaysia 2016; 71:72-73. [PMID: 27326946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Staphylococcus Aureus is a Gram-positive cocci bacteria which had been found to be the causative organism in over 88% of patients with primary iliopsoas abscess. We report the case of a 53-year-old diabetic woman with end-stage renal failure diagnosed with left iliopsoas abscess with a catheter-related infection. Computed tomogram (CT) of abdomen and pelvis revealed hypodense lesions of left psoas, iliacus and quadratus lumborum suggestive of psoas abscesses. In addition, osteomyelitis changes at left sacroiliac and hip joint were seen. At surgery, she was found to have abscess at the posterior psoas muscle where she underwent open surgery drainage and percutaneous drain was inserted. A high index of suspicion of iliopsoas abscess should be maintained among haemodialysis patients presenting with intradialytic pelvic and hip pain and treated with optimal antibiotics therapy with appropriate surgical intervention.
Collapse
Affiliation(s)
- M T Alif Adlan
- Hospital Bentong, Department of Medicine, Bentong, Pahang, Malaysia.
| | | | - M D Mohd Ramadhan
- Hospital Sultan Haji Ahmad Shah, Department of Medicine, Temerloh, Pahang, Malaysia
| |
Collapse
|
10
|
Wang Q, Hu M, Ma YZ, Luo XB. [Case-control studies of two kinds of method for the treatment of lumbar tuberculosis with psoas abscess]. Zhongguo Gu Shang 2016; 29:33-37. [PMID: 27019894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To compare two kinds of method for treating lumbar tuberculosis with psoas abscess, to provide reference for clinical reasonable select of therapy treatment. METHODS From January 2010 to January 2013,42 patients with lumbar tuberculosis combined with psoas abscess with obvious surgical indications were enrolled, including 24 males and 18 females with an average age of (38.5 ± 10.2) years old ranging from 21 to 63 years old. All patients were followed up for 18 to 24 months with an average of 20.9 months. Twenty-two patients underwent posterior vertebral body lesions cleared, bone graft fusion and internal fixation and percutaneous puncture catheter drainage for treatment of psoas major abscess as group A, and twenty patients underwent one-stage extraperitoneal approach to remove abscess, posterior vertebral body lesions cleared, bone graft fusion and internal fixation as group B. The operative time, loss of blood, length of hospital stay, clinical cure rate and other clinical results for the two groups were analyzed and compared. RESULTS The loss of blood was (452.3 ± 137.6) ml in group A and (603.5 ± 99.6) ml in group B, there was significant statistical difference (P < 0.05). The time of operation was (193.6 ± 91.2) min in group A and (230.5 ± 56.6) min in group B, there was significant statistical difference (P < 0.05). The time of operation and the loss of blood in group A were obviously less than which in group B. In group A 20 cases were cured and 2 cases relapsed, 19 cases were cured and 1 case relapsed in group B, there was no significant statistical differences between two groups regarding cure rate with chi-square test (χ² = 0.000, P = 1.000). All patients in two groups obtained good clinical curative effect. There were no significant statistical difference between two groups regarding for length of hospital stay with t-test (P > 0.05). CONCLUSION Lumbar spinal tuberculosis with psoas abscess is not absolute indications for anterior open operation. Compared with the combined anterior and posterior surgical procedure, the percutaneous puncture catheter drainage combined with posterior debridement, interbody fusion and internal fixation can achieve the same clinical effect but less trauma for the patients.
Collapse
|
11
|
Salášek M, Pavelka T. [Septic Sacroiliitis Complicated by a Pseudoaneurysm of the Internal Iliac Artery. A Case Report]. Acta Chir Orthop Traumatol Cech 2016; 83:50-54. [PMID: 26936067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The case of a 67-year-old woman with a combination of pelvic pyomyositis and left-sided sacroiliitis is reported. After a failed two-week antibiotic therapy, CT-guided percutaneous drainage of psoas muscle abscesses was performed and methicillin-resistant Staphylococcus aureus (MRSA) was isolated. Subsequently, a regression of symptoms was observed. At 6.5 weeks after the onset of symptoms, progression of sacroiliac joint (SI) destruction was again observed and an open revision of the SI joint was indicated (posterior approach, drainage and lavage). This again was followed by symptom regression. At 9.5 weeks after the patient was admitted, her condition markedly deteriorated and a large gluteal abscess was detected on CT examination. The second revision surgery was complicated by massive bleeding and, due to a septic pseudoaneurysm, internal iliac artery ligation was necessary. A significant subsidence of inflammatory changes and no pseudoaneurysm were shown on the follow-up CT scan. The intravenous antibiotic therapy with clindamycin was continued. At follow-up, repeated microbiological cultures from both tissue samples and drained secretions were all negative and CT scanning detected neither any fluid around the SI joint nor a pseudoaneurysm.
Collapse
Affiliation(s)
- M Salášek
- Klinika ortopedie a traumatologie pohybového ústrojí, Lékařská fakulta Univerzity Karlovy a Fakultní nemocnice Plzeň
| | | |
Collapse
|
12
|
Okada A, Hangai M, Oda T. Bacteremia with an iliopsoas abscess and osteomyelitis of the femoral head caused by Enterococcus avium in a patient with end-stage kidney disease. Intern Med 2015; 54:669-74. [PMID: 25786461 DOI: 10.2169/internalmedicine.54.3576] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A 70-year-old man on hemodialysis for end-stage kidney disease due to polycystic kidney disease presented with hip pain on extension and a high C-reactive protein level. Further examinations revealed an iliopsoas abscess and femoral head osteomyelitis caused by Enterococcus avium (E. avium) detected in blood and pus cultures. Complete resolution of the infection with ampicillin-resistant E. avium required six months of vancomycin therapy and two surgical drainage procedures. There have been no previous case reports in which both blood and abscess cultures confirmed E. avium infection. Careful attention should be paid to the detection of non-specific symptoms in patients on hemodialysis, with blood cultures being essential in such cases.
Collapse
Affiliation(s)
- Akira Okada
- Department of Nephrology, Showa General Hospital, Japan; Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Japan
| | | | | |
Collapse
|
13
|
Abstract
Objective Patients diagnosed with psoas abscess have a high mortality rate. The major cause of its poor prognosis is delayed treatment. Therefore, making a correct diagnosis rapidly is important. Both computed tomography (CT) and magnetic resonance imaging (MRI) are considered to be the gold standards as imaging modalities that have a high sensitivity for detecting psoas abscess. There have been few reports regarding the limitations of these methods, but psoas abscess in its early stage may go undetected by CT and MRI. Methods Detection of psoas abscess by CT and MRI was investigated in the present study through a retrospective review of 15 patients in whom psoas abscess was diagnosed during a course of ten years at our hospital. Results In all patients, psoas abscess was diagnosed by at least a plain CT, enhanced CT, and/or plain MRI. The interval between the onset of symptoms and diagnosis was 20.9±17.9 days (mean ± standard deviation). In three patients, repeat imaging identified a psoas abscess, whereas initial imaging failed to detect it. The overall sensitivity of plain CT, enhanced CT, and plain MRI for psoas abscess was 78%, 86%, and 88%, respectively. From six days after the onset of symptoms, the sensitivity of each modality was 100%, while the sensitivity from day one to five days was only 33%, 50%, and 50%, respectively. Conclusion Although CT and MRI are considered to be gold standard modalities for diagnosing psoas abscess, both methods can fail to notice this condition in its early stage.
Collapse
|
14
|
Otowa Y, Sumi Y, Kanaji S, Kanemitsu K, Yamashita K, Imanishi T, Nakamura T, Suzuki S, Tanaka K, Kakeji Y. Appendicitis with psoas abscess successfully treated by laparoscopic surgery. World J Gastroenterol 2014; 20:8317-8319. [PMID: 25009411 PMCID: PMC4081711 DOI: 10.3748/wjg.v20.i25.8317] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/25/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
Although acute appendicitis is a common disease, retroperitoneal abscesses are rarely observed. Here, we report a case consisting of a psoas abscess and cutaneous fistula caused by appendicitis. The patient was a 56-year-old male who was introduced to our institution due to an intractable right psoas abscess. Imaging tests had been performed over the previous 3 years; however, clinicians could not find the origin of the abscess and failed to resolve the problem. A successful operation was performed via a laparoscopic approach, and 17 mo have passed without recurrence. The advantage of laparoscopic surgery is well understood in cases of appendicitis with abscesses. However, the indication for laparoscopic approach is not clear for retroperitoneal abscesses. From our experience, we can conclude that appendicitis with retroperitoneal abscesses can be managed and treated using a laparoscopic approach.
Collapse
|
15
|
Vicente-Ruiz M, Candel-Arenas MDLF, Ruiz-Marín M, Peña-Ros E, Sánchez-Cifuentes A, Albarracín Marín-Blázquez A. [Psoas abscess as a differential diagnosis in emergency department]. CIR CIR 2014; 82:268-273. [PMID: 25238468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND A psoas (or iliopsoas) abscess is a rare clinical entity with a wide etiological range. It is defined as a collection of pus that begins and extends through the iliopsoas muscle and can reach up to the inguinal region. METHODS We performed a retrospective descriptive study by reviewing medical records from the General Surgery department of Reina Sofía's General University Hospital. Information was collected from patients diagnosed with psoas abscess who were admitted to the General Surgery department from 2006 to 2011. RESULTS Five cases were reported for 6 years: four males (80%) and one female (20%). Average age was 51.6 years (range: 35--75). All were admitted to the hospital through the Emergency Department. Lumbar pain, fever and rash were clinical features in three patients. Two patients initiated with septic shock. Each patient had computed tomography performed, which confirmed the diagnosis. Causes of the abscess were as follows: one perforated colon neoplasm, two left hip osteomyelitis, one Crohn's disease and one primary abscess. Surgery was the treatment in three cases and placement of pigtail drainage was the treatment in two patients. Two patients were admitted to the Intensive Care Unit and ultimately died. CONCLUSION In our case series report, it is seen that treatment delay developed to septic shock and death. We should consider this entity in emergency practice in order to carry out timely treatment.
Collapse
Affiliation(s)
- María Vicente-Ruiz
- Cirugía General y del Aparato Digestivo, Hospital General Reina Sofía, Murcia, Spain.
| | | | - Miguel Ruiz-Marín
- Cirugía General y del Aparato Digestivo, Hospital General Reina Sofía, Murcia, Spain
| | - Emilio Peña-Ros
- Cirugía General y del Aparato Digestivo, Hospital General Reina Sofía, Murcia, Spain
| | | | | |
Collapse
|
16
|
Neola B, D'Ambra M, Capasso S, Russo M, Ferulano GP. Laparoscopic drainage of a recurrent psoas abscess. Ann Ital Chir 2014; 85:S2239253X14021847. [PMID: 24709630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Many Authors suggest that psoas abscess should initially undergo an antibiotic therapy, with or without percutaneous drainage. In their opinion, surgical drainage should be done in case of failure or complicated recurrences. Herein we report a laparoscopic drainage of a recurrent and multilocular psoas abscess. METHODS A 43-year-old woman presented to our department with a 4-week history of fever, anorexia, difficulty in walking, and pain in her right flank, lower back and hip. She had a 20-year history of recurrent lower back pain and fever treated with cyclic antibiotic therapy. Abdominal CT scan showed a complex multilocular right psoas abscess and a 17 mm hypodense area in the sixth liver segment. A drainage of the abscess through a laparoscopic access with intraoperative laparoscopic ultrasound of the liver was decided. RESULTS The patient was discharged on the 3 th postoperative day. Her white blood cell count was normal and she was symptom free. At 1-, 6-, 12- and 24-months-follow-up, neither fever nor lower back pain were reported. CONCLUSIONS According to our experience, laparoscopic drainage of iliopsoas abscess is safe and effective. However, further studies comparing laparoscopic drainage with open drainage and percutaneous drainage are required in order to define the specific indications of laparoscopic drainage.
Collapse
|
17
|
Affiliation(s)
- Shuntaro Matsuda
- Faculty of Medicine, Department of Community and Family Medicine, University of Miyazaki, Japan
| | | | | | | |
Collapse
|
18
|
López-Zabala I, García-Ramiro S, Bori G, Gallart X, Tomás X, Fuster D, Mensa J, Soriano A. [Psoas abscess associated with hip arthroplasty infection]. Rev Esp Quimioter 2013; 26:198-202. [PMID: 24080885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Psoas abscess associated with hip arthroplasty infection is a rare entity. The aim of this report was to review our experience. MATERIAL AND METHODS Patients with computerized tomography (CT) diagnosis of psoas abscess associated with a hip arthroplasty infection from 2004 to 2009 were retrospectively reviewed. Demographics, microbiological data, CT results and outcome of each patient were recorded. RESULTS Seven patients out of 214 evaluated by CT due to hip infection suspected were identified. Three women and 4 men, with a mean age of 69 years (range 46-89). Mean abscess diameter was of 62 x 47 mm. In all cases, a direct communication between abscess and prosthesis was observed. The most commonly isolated microorganisms were grampositive cocci. All patients were treated with two-stage revision surgery. After a mean follow-up of 65 months (28-113), six patients were in remission. CONCLUSIONS The use of CT in the study of suspected infection of a hip arthroplasty identified a psoas abscess in 7 cases out of 214 evaluated. Patients treated with two-stage revision surgery and large debridement was associated with a good clinical outcome.
Collapse
Affiliation(s)
- Ibon López-Zabala
- Ibon López Zabala, Servicio de Cirugía Ortopédica y Traumatología, Instituto Clinic de Especialidades Médico-Quirúrgicas (ICEMEQ), Hospital Clínic. Universitat de Barcelona, C/ Villarroel 170. 08036 Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Demetriou GA, Nair MS, Navaratnam R. Right-sided colonic tuberculosis: a rare cause of ilio-psoas abscess. BMJ Case Rep 2013; 2013:bcr-2013-009722. [PMID: 23616337 DOI: 10.1136/bcr-2013-009722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Ilio-psoas abscess due to right colon origin is rare and normally occurs secondary to Crohn's disease, diverticulitis or cancer. We report a case of a caecal tuberculosis (TB) presented initially with an appendicular mass and systemic symptoms of fever and fatigue and 3 weeks after, with right-sided anterior thigh pain and found to have an ilio-psoas abscess. Colonoscopy and histology confirmed the diagnosis of caecal-TB. She had a CT drainage of the abscess and was discharged with anti-TB treatment and her drain in situ. Repeat pelvic MRI 10 days after treatment showed the abscess resolving and her systemic symptoms improving.
Collapse
Affiliation(s)
- George A Demetriou
- North Middlesex University Hospital, Department of Emergency Medicine, London, UK.
| | | | | |
Collapse
|
20
|
Sopena Bert E, Cortiella Masdeu A, Qanneta R, Moltó Llarena E. [Soft tissue infection by probable community-acquired methicillin-resistant Staphylococcus aureus]. Rev Argent Microbiol 2013; 45:61. [PMID: 23560792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
|
21
|
García-Santos EP, Menéndez Sánchez P, Muñoz-Atienza V, Sánchez-García S, Ruescas-García FJ, Valle-García R, Bertelli-Puche JL, Padilla-Valverde D, Villarejo-Campos P, Gil-Rendo A, Jara-Sánchez A, Reina Escobar D, Martín-Fernández J. [Necrotizing fasciitis as a form of presentation of acute gangrenous appendicitis]. Gastroenterol Hepatol 2012; 35:676-7. [PMID: 23046925 DOI: 10.1016/j.gastrohep.2012.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 04/30/2012] [Accepted: 05/10/2012] [Indexed: 11/16/2022]
|
22
|
Kawashima M, Hashimoto Y, Sudo T, Uemura K, Nakashima A, Sueda T, Murakami Y. A rare diagnostic challenge in acute appendicitis: a case report. Hiroshima J Med Sci 2012; 61:19-21. [PMID: 22702216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Although rare, acute appendicitis presenting as a remote abscess with cellulitis in the gluteal region, retroperitoneal region, groin, or thigh does occur and may present a diagnostic challenge. We report a case of a 78-year-old woman presenting with an extensive gas-forming abscess in the right gluteal region secondary to perforated appendicitis without significant gastrointestinal symptoms. Computed tomography (CT) demonstrated a retroperitoneal abscess extending along the sacropelvic surface of the ilium to the subcutaneous tissue. Subsequently, laparotomy revealed retrocecal appendicitis perforated at the base of the cecum, and contained in the retroperitoneum without any signs of peritonitis. This case not only represents an unusual manifestation of acute appendicitis, but also alerts us to the importance of anatomical considerations when interpreting disease extent with imaging. In the differential diagnosis of gluteal or upper thigh abscesses, the rare possibility of perforated acute appendicitis should be considered.
Collapse
Affiliation(s)
- Masumi Kawashima
- Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University Hiroshima 734-8551, Japan
| | | | | | | | | | | | | |
Collapse
|
23
|
Wang E, Ma L, Edmonds EW, Zhao Q, Zhang L, Ji S. Psoas abscess with associated septic arthritis of the hip in infants. J Pediatr Surg 2010; 45:2440-3. [PMID: 21129563 DOI: 10.1016/j.jpedsurg.2010.07.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 07/21/2010] [Accepted: 07/27/2010] [Indexed: 11/17/2022]
Abstract
We describe psoas abscess with concomitant septic hip arthritis in 2 infants, 3 and 7 months old. The common clinical features were a palpable mass in the inguinal region, irritable hip, and delayed treatment. The diagnosis of septic hip was delayed in one child, and they both had residual hip deformity at follow-up. It is possible that initial delay in diagnoses resulted in the concurrent pathologic condition because of spread of infection. These 2 cases demonstrate the first known reports of concurrent psoas abscess and septic hip arthritis in infancy. Magnetic resonance imaging is a valuable method to identify these concurrent pathologic conditions. A proposed etiologic mechanism is also discussed in the article.
Collapse
Affiliation(s)
- Enbo Wang
- Department of Pediatric Orthopaedics, Shengjing Hospital, China Medical University, Shenyang, 110004, China
| | | | | | | | | | | |
Collapse
|
24
|
Langille GM, Norman RW. Psoas abscess from ureteric stone perforation. Can J Urol 2010; 17:5408-5410. [PMID: 20974040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This case illustrates a rare complication of an impacted ureteric stone which eroded through the wall of the ureter leading to formation of a psoas abscess. Ureteric stent placement and percutaneous drainage of the abscess were insufficient to resolve the problem. Renal scan revealed poor function and the left kidney was removed. It showed evidence of acute supporative pyelonephritis with nephrolithiasis.
Collapse
Affiliation(s)
- Gavin M Langille
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | |
Collapse
|
25
|
González Robledo J, Pérez Losada ME, Ballesteros Herráez JC, Rodríguez Encinas A. [Septic shock due to primary myonecrosis of psoas]. Med Intensiva 2010; 35:196. [PMID: 20692075 DOI: 10.1016/j.medin.2010.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 07/07/2010] [Accepted: 07/08/2010] [Indexed: 11/29/2022]
|
26
|
|
27
|
Abstract
Buttock abscess is a rare clinical manifestation from unusual extrapelvic extension of psoas abscess. A 48-year-old woman presented with painful swelling of the buttock with a sense of local heat. Magnetic resonance imaging revealed a large subfascial abscess over the glutei muscles and was traced into the intraabdominal cavity over the iliac wing to the psoas muscle. Both the psoas abscess and the buttock abscess were evacuated via separate approaches. Empirical antibiotic therapy was delivered for 3 weeks. After 6 months, no evidence of recurrence was found. Psoas abscess could be included in the differential diagnosis of buttock abscess.
Collapse
Affiliation(s)
- Jae Ho Yoo
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital, Bucheon, Gyeonggi-do, 420-767, South Korea.
| | | | | | | |
Collapse
|
28
|
Blomstrand D, Prytz H. [Iliopsoas abscess--difficult to suspect, easy to diagnose]. Lakartidningen 2009; 106:1652-1654. [PMID: 19630294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
29
|
Lam MY, Feller ER, Lonks JR, Shah SA. Inflammatory bowel disease potpourri: a vignette-based discussion. Med Health R I 2009; 92:121-124. [PMID: 19452754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Manuel Y Lam
- The Warren Alpert Medical School of Brown University, USA
| | | | | | | |
Collapse
|
30
|
Abstract
Haemophilus aphrophilus is one of the normal oropharyngeal flora and rarely implicated as a pathogen of spinal infection. A case of H. aphrophilus bacteremia complicated with epidural abscess, psoas muscle abscess, and spondylodiscitis is described in this report. The pathogen was mis-identified as Pasteurella spp. at the very start, and was confirmed by the molecular method. He was successfully treated with adequate antibiotics and surgery. The clinical features of sixteen previously reported cases of spinal infection caused by H. aphrophilus are reviewed.
Collapse
Affiliation(s)
- Jui-Teng Chien
- Department of Orthopedics, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, ROC
| | | | | | | | | | | |
Collapse
|
31
|
Saedon M, Shore S, Hanafy M. Image of the month. Septic arthritis. Arch Surg 2008; 143:913-914. [PMID: 18794432 DOI: 10.1001/archsurg.143.9.913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Mahmud Saedon
- Surgical Department, Leighton Hospital, Crewe, England.
| | | | | |
Collapse
|
32
|
Fujioka M, Yoshida S, Kitamura R, Matsuoka Y. Iliopsoas muscle abscess secondary to sacral pressure ulcer treated with computed tomography-guided aspiration and continuous irrigation: a case report. Ostomy Wound Manage 2008; 54:44-48. [PMID: 18716341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Iliopsoas abscess is an aggressive infection usually associated with Crohn's disease, spinal tuberculosis, a septic hip joint (including hip replacement), and spinal cord injury. It rarely occurs secondary to sacral pressure ulcer. The infection requires immediate surgical debridement or drainage. The case of a 78-year-old woman with high fever and severe inflammation caused by iliopsoas abscess secondary to a sacral pressure ulcer is reported. The patient was treated with a computed tomography-guided aspiration; Escherichia coli was isolated from the pus of the ulcer and abscess sites. The abscess completely resolved within 2 weeks but another abscess developed. Following surgery and daily cleansing, the drainage tube was removed after 1 week. Once granulation tissue formation was sufficient, the sacral wound was covered with gluteal fasciocutaneous rotation flaps 6 weeks after admission. The wounds closed and the patient made a full recovery within 2 months. Early recognition followed by immediate drainage of pus and appropriate antibiotic therapy are essential to the treatment of these wounds. Experience confirms that computed tomography-guided aspiration is useful and may be less damaging than surgical debridement.
Collapse
Affiliation(s)
- Masaki Fujioka
- Department of Plastic and Reconstructive Surgery, National Nagasaki Medical Center, Nagasaki, Japan.
| | | | | | | |
Collapse
|
33
|
Assenza M, Antoniozzi A, Clementi I, Bartolucci P, Ciccarone F, Simonelli L, Valesini L, Ricci G, Modini C. Primary psoas abscess in a patient affected by acquired immunodeficiency syndrome: a rare case according to the reviewed literature. Clin Ter 2008; 159:261-263. [PMID: 18776984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Abscesses of the psoas muscle can be divided into primary and secondary. In the primary ones, it is not possible to identify any further infected site. The localization to this muscle is due to its rich vascularization and Staphylococcus aureus is the most frequent aetiological agent of the infection. Treatment requires the use of appropriate antibiotics, as well as surgical or percutaneous drainage of the abscess. The percutaneous drainage is much less invasive and a low risk in the patients with acquired immunodeficiency syndrome, and is effective for draining even multiloculated abscess. The authors present a rare case of primary psoas abscess in patient affected by acquired human immunodeficiency syndrome, showing a mass in the inferior lumbar region through the lumbar triangle of Petit and fever. Treatment consisting in percutaneous drainage combined with systemic antibiotic administration was successful.
Collapse
Affiliation(s)
- M Assenza
- Dipartimento di Emergenza Urgenza, Azienda Policlinico Umberto I, Sapienza Università di Roma, Italia.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Puglisi R, Murmura C, Piombo A, Quaglia F. [Retroperitoneal abscess due to asymptomatic duodenal perforation by foreign body. A case report]. G Chir 2008; 29:180-181. [PMID: 18419986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We present a case of retroperitoneal abscess due to asymptomatic duodenal perforation by foreign body. Patient has been admitted for lumbar pain and subocclusive crisis, with a medical history negative for acute symptomatology. After both clinical and radiologic evaluation, an abscess-like mass was detected in the context of right psoas muscle. Patient underwent surgical operation and a lumbar abscess has been found containing a foreign body (toothpick). There has been a transduodenal migration of the foreign body, without clinical signs of duodenal perforation.
Collapse
Affiliation(s)
- R Puglisi
- UO Chirurgia Generale, Azienda Ospedaliera Villascassi, Genova
| | | | | | | |
Collapse
|
35
|
Ebraheim NA, Rabenold JD, Patil V, Sanford CG. Psoas abscess: a diagnostic dilemma. Am J Orthop (Belle Mead NJ) 2008; 37:E11-E13. [PMID: 18309388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Nabil A Ebraheim
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH 43614, USA
| | | | | | | |
Collapse
|
36
|
Abstract
BACKGROUND Psoas abscess is an uncommon disease, and its presenting features are usually nonspecific. Infected aortic aneurysms could be complicated by psoas abscess. METHODS A retrospective chart review was conducted to examine the incidence, clinical presentations, microbiology, and outcomes of psoas abscess in patients with an infected aortic aneurysm. RESULTS Between 1996 and 2007, 40 patients (32 men) with an infected infrarenal aortic aneurysm were treated in our hospital. Their median age was 71 years (range, 38 to 88 years). In 38 patients a blood or tissue culture had a positive result. The most common responsible pathogen was Salmonella spp in 29 patients (76%), followed by Staphylococcus aureus in 3 (8%), Escherichia coli in 2 (5%), Klebsiella pneumoniae in 3 (8%), and Mycobacterium tuberculosis in 1 (3%). One patient underwent endovascular repair but died. In-situ graft replacement was done in 32 patients. Persistent or recurrent infection occurred in seven (22%) of 32 operated on patients. The mortality rate was 86%, and the overall aneurysm-related mortality rate of in situ graft replacement was 22% (7/32). In eight (20%) of the 40 patients, aortic infection was complicated by psoas abscess. Infection complicated by psoas abscess was present in seven of 32 operated patients. It was associated with higher incidence of emergency operation, hospital mortality, prosthetic graft infection, and aneurysm-related mortality than infection without abscess. CONCLUSION Psoas abscess was common in patients with infected infrarenal aortic aneurysm. Salmonella spp was the most common pathogen. Psoas abscess was associated with a high mortality rate, emergency operation, and persistent infection.
Collapse
Affiliation(s)
- Ron-Bin Hsu
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China
| | | |
Collapse
|
37
|
Mao Martín L, Urbán Poza MA, Torres Gárate R, Alvarez Rodríguez E, Valle Borrego B, Baquedano Sánchez F, Díaz Ortiz M. [Pain and functional impotence in the lower left extremity and painful mass in left hemiabdomen]. An Med Interna 2007; 24:49-50. [PMID: 17489140 DOI: 10.4321/s0212-71992007000100013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
|
38
|
Katsuragi N, Shiraishi Y, Kita H. [Case of tuberculous psoas abscess successfully treated with surgery during antituberculosis therapy for miliary tuberculosis]. Kekkaku 2006; 81:661-5. [PMID: 17154044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
A case of tuberculous psoas abscess complicated during antituberculosis therapy for miliary tuberculosis and successfully treated with surgery was reported. A 20-year-old man visited our hospital because of fever lasting for 3 months. Chest radiography showed miliary nodules in both lungs and transbronchial lung biopsy revealed granuloma. Magnetic resonance imaging of the head showed small lesions in the brain. Computed tomography of the abdomen showed an enlarged paraaortic lymph node and a nodule in the spleen. Needle biopsy of the lymph node revealed necrotic tissue. Mycobacterium tuberculosis was not isolated; however, miliary tuberculosis was highly suspected based on clinical and radiographic findings. Once antituberculosis therapy was initiated with isoniazid, rifampicin, streptomycin, and pyrazinamide, the fever subsided. In spite of improvement of general radiographic findings, a new abscess was found in the right psoas major muscle after 8 months of therapy by computed tomography. A sample of the abscess showed a positive smear, negative culture, and positive PCR test for M. tuberculosis. Although antituberculosis therapy continued for another 6 months, the abscess enlarged to 7 cm and new retroperitoneal lymph nodes also appeared. Surgical drainage and curettage of the abscess was performed. Intra- and post-operative specimens were negative for bacteria, fungi, and M. tuberculosis. The patient was treated with isoniazid, rifampicin, and ethambutol for one year postoperatively. The disease disappeared without any evidence of relapse for 2.5 years after surgery.
Collapse
Affiliation(s)
- Naoya Katsuragi
- Section of Chest Surgery, Fukujuji Hospital, JATA, 3-1-24, Matsuyama, Kiyose-shi, Tokyo 204-8522 Japan.
| | | | | |
Collapse
|
39
|
Affiliation(s)
- A Patil
- Department of Obstetrics and Gynaecology, Ninewells Hospital, Dundee, Scotland, UK.
| | | | | | | |
Collapse
|
40
|
Devetag Chalaupka F. Acute iliopsoas and adductor brevis abscesses presenting with proximal leg muscle weakness. Neurol Sci 2006; 27:125-8. [PMID: 16816911 DOI: 10.1007/s10072-006-0613-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2005] [Accepted: 02/10/2006] [Indexed: 12/01/2022]
Abstract
Pyomyositis is a bacterial infection of skeletal muscle. We describe the clinical case of a 77-year-old woman affected by gait disturbance, repetitive falls, low back pain and left thigh and groin pain, but without symptoms of systemic infection. Computed tomography and magnetic resonance imaging of the abdomen and pelvis showed abscesses in the left psoas and adductor brevis muscles. Investigations of urogenital tract and gastrointestinal system were normal. Systemic antibiotic treatment alone was not efficient, while surgical drainage improved the clinical picture. The aetiological organism, isolated from the abscess, was Staphylococcus aureus. We suggest that this patient had a primary pyomyositis rather than a secondary form. This is the first report of concomitant abscesses of psoas and adductor brevis muscles with early neurological involvement.
Collapse
Affiliation(s)
- F Devetag Chalaupka
- Department of Neurology and Clinical Neurophysiology, Ospedale S. Maria del Prato, ULSS 2-Veneto, Via Bagnols sur Cèze 3, I-32032, Feltre, Italy.
| |
Collapse
|
41
|
Klonaris C, Vourliotakis G, Katsargyris A, Tsiodras S, Bastounis E. Primary Aortoduodenal Fistula without Abdominal Aortic Aneurysm in Association with Psoas Abscess. Ann Vasc Surg 2006; 20:541-3. [PMID: 16625413 DOI: 10.1007/s10016-006-9039-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Revised: 02/06/2006] [Accepted: 02/17/2006] [Indexed: 10/24/2022]
Abstract
Primary aortoenteric fistula (PAEF) is a communication between the aorta and the enteric tract without any previous vascular intervention, e.g., aortic grafting. Although rare, PAEF is a potentially lethal condition that requires a high index of suspicion and prompt surgical intervention. Most of the reported cases involve an abdominal aortic aneurysm. However, in this report, we describe a rare case of a primary aortoduodenal fistula in a nonaneurysmal aorta in association with a psoas abscess, which was treated successfully. At 2-year follow-up, the patient is alive without episodes of bleeding or fever.
Collapse
Affiliation(s)
- Chris Klonaris
- Vascular Division, 1st Surgical Department, Laikon Hospital, University of Athens Medical School, Athens, Greece.
| | | | | | | | | |
Collapse
|
42
|
Agostini A, De Lapparent T, Bretelle F, Roger V, Cravello L, Blanc B. Abscess of the thigh and psoas muscle after transobturator suburethral sling procedure. Acta Obstet Gynecol Scand 2006; 85:628-9. [PMID: 16752248 DOI: 10.1080/00016340600608485] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Aubert Agostini
- Department of Obstetrics and Gynecology, La Conception University Hospital, Marseille, France.
| | | | | | | | | | | |
Collapse
|
43
|
Vilar FC, Neves FF, Colares JKB, da Fonseca BAL. Tuberculose vertebral (doença de Pott) associada a abscesso de psoas: relato de dois casos e revisão da literatura. Rev Soc Bras Med Trop 2006; 39:278-82. [PMID: 16906254 DOI: 10.1590/s0037-86822006000300011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 03/31/2006] [Indexed: 11/22/2022] Open
Abstract
A tuberculose é uma das principais doenças infecciosas de acometimento mundial com 3,9 milhões de casos notificados no mundo, em 2002. A forma esquelética pode corresponder a 3% do número total de casos, sendo 50% devido à tuberculose vertebral. O abscesso de psoas é uma entidade clínica rara com aproximadamente 12 casos relatados por ano na literatura médica e tem no Mycobacterium tuberculosis, um dos seus agentes etiológicos. O objetivo deste trabalho é relatar dois casos de tuberculose vertebral associada a abscesso de psoas atendidos em nosso serviço, bem como uma revisão da literatura.
Collapse
Affiliation(s)
- Fernando Crivelenti Vilar
- Divisão de Moléstias Infecciosas, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes 3900, 14048-900 Ribeirão Preto, SP
| | | | | | | |
Collapse
|
44
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- P K Baier
- Department of Visceral and General Surgery, University of Freiburg, Hugstetterstasse 55, 79104, Freiburg, Germany.
| | | | | | | |
Collapse
|
45
|
Pérez-Fernández S, de la Fuente-Aguado J, Fernández-Fernández FJ, Rubianes-González M, Sopeña Pérez-Argüelles B, Martínez-Vázquez C. Abscesos del psoas. Una perspectiva actual. Enferm Infecc Microbiol Clin 2006; 24:313-8. [PMID: 16762257 DOI: 10.1157/13089666] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze the characteristics of abscesses of the psoas muscle and assess the differences between pyogenic and tuberculous abscesses. METHODS Retrospective descriptive study of all patients with psoas abscess in our hospital over the period 1994 to 2004. RESULTS Fourteen patients were studied (10 males), with a mean age of 42 years. Half of them had had an underlying disease. The most frequent clinical manifestations were abdominal pain (64%), fever (57%), and back pain (43%). All the abscesses were secondary. In 7 patients the origin was gastrointestinal, in 6 osteoarticular, and 1 was related with infection of an aortobifemoral bypass. Computed tomography was the diagnostic imaging method in all patients. Culture of drainage specimens was positive in 92% of patients undergoing this procedure. Causal microorganisms included Mycobacterium tuberculosis (5), Streptococcus intermedius (4), Staphylococcus aureus (3), Escherichia coli (3) and Bacteroides fragilis (2). Tuberculous abscesses originated in spondylitis and the clinical presentation was longer prior to diagnosis. Drainage was performed in 12 patients (8 percutaneous and 4 surgical). Mean duration of antimicrobial therapy was 4 weeks. The infection resolved in all patients. CONCLUSIONS Psoas abscess commonly had a gastrointestinal and osteoarticular origin. We underscore the high percentage of tuberculous etiology, which had a more insidious clinical and analytical presentation and was usually secondary to spondylitis. Prolonged antimicrobial treatment associated with drainage was effective therapy.
Collapse
Affiliation(s)
- Silvia Pérez-Fernández
- Servicio de Medicina Interna, Complexo Hospitalario Universitario de Vigo, Pontevedra, España.
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
About 70 patients admitted with psoas abscess are reviewed. The ratio of non-tubercular to tubercular psoas abscess was 6:1 and left-to-right psoas involvement was 1.6:1. Iliac fossa mass and neutrophilic leucocytosis were found in all the patients without any underlying bony involvement. Ultrasonography and needle aspiration of pus were followed by surgical drainage. Staphylococcus aureus was the most common organism cultured.
Collapse
Affiliation(s)
- Utpal De
- Department of Surgery, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal 722102, India.
| | | |
Collapse
|
47
|
Abstract
Infection of the hip joint following psoas abscess is uncommon. In fact, only two cases have been reported in the literature. The clinical aspect of psoas abscess is characterised only by unspecific back pain and hip pain, which are responsible for delayed diagnosis. MRT and culture of joint aspirate can permit early diagnosis. The preferred treatment is immediate surgical intervention with debridement, drainage and antibiotic therapy. Percutaneous drainage of psoas abscess alone only rarely is sufficient. In cases of infected hip joint, resection arthroplasty often cannot be avoided. Following complete decline of inflammatory parameters and certain absence of bacteria confirmed by repeated joint aspiration, prosthetic joint replacement is possible. This decision should be made on an individual basis, because Girdlestone hip also can lead to a satisfactory result concerning pain relief and functional outcome.
Collapse
Affiliation(s)
- F Auerbach
- Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum, Uelzen.
| | | | | |
Collapse
|
48
|
Jackisch T, Freitag M, Ludwig K. [Gas gangrene with ulcerative colitis under immunosuppressive therapy: report of a case]. Zentralbl Chir 2006; 131:84-7. [PMID: 16485217 DOI: 10.1055/s-2006-921399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report on a 30-year-old male with ulcerative colitis who developed a spontaneous gas gangrene in the right limb, the gluteal muscles and the retroperitoneal region under immunosuppressive therapy. In spite of immediate aggressive surgical and antibiotic therapy the massive infection led to septicemia and ultimately death. Clostridium septicum was identified with multiple local manifestations in the skeletal muscles. Gas gangrene is extremely rare in patients with ulcerative colitis or Crohn's disease and immunosuppression. The therapeutic options are discussed and the relevant present literature is reviewed.
Collapse
Affiliation(s)
- T Jackisch
- Klinik für Allgemein- und Abdominalchirurgie, Krankenhaus Dresden-Friedrichstadt, Akademisches Lehrkrankenhaus der TU Dresden, Friedrichstrasse 41, 02067 Dresden.
| | | | | |
Collapse
|
49
|
Abstract
Psoas abscess secondary to Mycobacterium tuberculosis infection is rare in industrialized countries. Standard treatment options for psoas abscess of any etiology include percutaneous drainage under radiographic guidance and surgery, which is reserved for failure of conservative therapy. A case of bilateral tuberculous psoas abscesses is reported and a surgical method of drainage utilizing a totally extraperitoneal laparoscopic approach is described.
Collapse
Affiliation(s)
- Gary Atkin
- From the Department of Surgery, Ealing Hospital NHS Trust, London, UK
| | | | | |
Collapse
|
50
|
Affiliation(s)
- Anthony C Venbrux
- Cardiovascular and Interventional Radiology, The George Washington University Medical Center, Washington, DC, USA
| | | | | | | |
Collapse
|