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Hamade YJ, Ogando-Rivas E, Tataryn ZL, Costa ML, Al-Khalili K, Yeung T, Pluemer J, Robinson JE, Abdul-Jabbar A, Kasper EM, Oskouian RJ, Chapman JR. Iliopsoas Abscesses: Whose Problem is it? Insights Gained by an Institutional 100-Patient Consecutive Case Series. World Neurosurg 2025; 198:123978. [PMID: 40239860 DOI: 10.1016/j.wneu.2025.123978] [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: 02/24/2025] [Accepted: 03/27/2025] [Indexed: 04/18/2025]
Abstract
BACKGROUND Iliopsoas abscess (IPA) is a rare but serious condition caused by hematogenous or contiguous spread of infection. Management typically involves broad-spectrum antibiotics, with percutaneous or surgical drainage for larger abscesses. METHODS We retrospectively reviewed 113 IPA cases at the Swedish Neuroscience Institute (2015-2024), analyzing demographics, clinical features, imaging, treatment strategies, hospital course, and outcomes. RESULTS Among 100 patients included, 86 presented with back or flank pain, 45 with abdominal pain, and 35 with lower extremity discomfort. The most common pathogens were Staphylococcus aureus (38%) and Escherichia coli (31%). Mean patient age was 56 years (range: 32-71); 29% had intra-abdominal inflammatory disease, 25% had bacteremia, and 32% were intravenous drug users. Antibiotics alone were successful in 16/21 patients (76%), while 5 (24%) required subsequent CT-guided percutaneous drainage (PCD). Among 72 patients undergoing PCD, 32 (44%) had successful treatment, 12 (17%) required multiple procedures, and 28 (39%) underwent surgery after failed drainage. Primary surgical drainage was performed in 7 patients (7%). Mean hospital stay was 21 days, and overall mortality was 5%, lower than reported rates (5%-15%). CONCLUSIONS First-line treatment for IPA includes antibiotics and PCD, with surgery reserved for complex cases, gas formation, neurological involvement, proximity to vertebrae or spinal hardware, or failure of initial treatment.
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Affiliation(s)
- Youssef J Hamade
- St. Elizabeth Medical Center at Boston University, Department of Neurosurgery, Brighton, Massachusetts, USA.
| | - Elizabeth Ogando-Rivas
- St. Elizabeth Medical Center at Boston University, Department of Neurosurgery, Brighton, Massachusetts, USA
| | - Zachary L Tataryn
- St. Elizabeth Medical Center at Boston University, Department of Neurosurgery, Brighton, Massachusetts, USA; Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Matias L Costa
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Kenan Al-Khalili
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Toching Yeung
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Jonathan Pluemer
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Jerry E Robinson
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Amir Abdul-Jabbar
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Ekkehard M Kasper
- St. Elizabeth Medical Center at Boston University, Department of Neurosurgery, Brighton, Massachusetts, USA; McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Rod J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
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Virji SN, Shahid M, Siddiqui MJ, Mahmood SF, Iqbal U, Khan S. Pseudomyxoma retroperitonei secondary to appendiceal mucinous adenocarcinoma disguised as psoas abscess - A case report. Int J Surg Case Rep 2025; 126:110827. [PMID: 39756236 PMCID: PMC11757770 DOI: 10.1016/j.ijscr.2025.110827] [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: 10/09/2024] [Revised: 12/25/2024] [Accepted: 01/02/2025] [Indexed: 01/07/2025] Open
Abstract
INTRODUCTION AND IMPORTANCE Appendiceal cancers are rare tumors, with mucinous cystadenocarcinoma accounting for 58 % of malignant appendiceal tumors. Mucinous cystadenocarcinomas are typically low grade but may lead to pseudomyxoma peritonei, causing accumulation of gelatinous material in the abdomen, often referred to as 'jelly belly'. In rare instances, the tumor may perforate into the retroperitoneal cavity leading to the phenomenon described as pseudomyxoma retroperitonei or extraperitonei. CASE PRESENTATION We describe the case of a young man presenting with a psoas abscess, initially treated with antibiotics. When the abscess failed to resolve, further testing was undertaken and revealed a diagnosis of mucinous adenocarcinoma with pseudomyxoma retroperitonei. The patient underwent a right hemicolectomy with debridement of the psoas abscess cavity. This case illustrates the need for a high index of suspicion for malignancy in the setting of recurrent or atypical psoas abscess. CLINICAL DISCUSSION Appendiceal mucinous neoplasms are found in <2 % of appendectomy cases. Due to the rarity of the pathology, they are often misdiagnosed as was in this scenario as a psoas abscess. Being in a tuberculosis-endemic area further complicated the diagnosis. Imaging and colonoscopy play a crucial in the proper, early diagnosis of these neoplasms that may present as a psoas abscess. CONCLUSION Appendiceal tumors initially presenting as psoas abscess can be misguiding, leading to dismissal of the underlying diagnosis. An appropriate diagnostic workup should be considered early in the disease course for prompt treatment of the condition.
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Affiliation(s)
- Safna Naozer Virji
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi 74800, Pakistan.
| | - Mehreen Shahid
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi 74800, Pakistan.
| | | | - Syed Faisal Mahmood
- Department of Infectious Diseases, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan.
| | - Usama Iqbal
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi 74800, Pakistan.
| | - Sadaf Khan
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi 74800, Pakistan.
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Miyakoda K, Ono R, Kitagawa I. A Case of Pott's Disease Complicated by Tuberculous Meningitis and Psoas Abscess Diagnosed by Computed Tomography-Guided Percutaneous Drainage. Cureus 2024; 16:e73750. [PMID: 39677164 PMCID: PMC11646450 DOI: 10.7759/cureus.73750] [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: 11/15/2024] [Indexed: 12/17/2024] Open
Abstract
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (MTB). Disseminated TB can cause various types of complications. Extrapulmonary TB includes TB meningitis, abdominal TB, skeletal TB, Pott's disease (spine), scrofula, and genitourinary TB. In particular, TB meningitis is a lethal complication of TB with a high mortality rate. The patient was an 84-year-old Japanese man with a history of tuberculous pleurisy during childhood who presented with fever and altered mental status. Eight months prior, the patient was diagnosed with a urinary tract infection and treated with levofloxacin, but further investigation showed spondylitis. Although the causative microorganism was not identified as levofloxacin likely masked it, he was treated with linezolid and rifampicin for six weeks for the empiric diagnosis of bacterial pyogenic spondylitis; both medications are also antituberculous agents. At this visit, abdominal computed tomography (CT) revealed a left psoas abscess with calcification, and cerebral magnetic resonance imaging revealed multiple nodules with target signs. Cerebrospinal fluid (CSF) findings were consistent with TB meningitis, though the TB polymerase chain reaction, culture, and CSF cytology were all negative. He underwent CT-guided percutaneous drainage for the psoas abscess, and MTB was finally identified. Although he was treated with antituberculous agents including rifampicin, ethambutol, and isoniazid, the patient died seven months after admission as a result of the debilitating effects of tuberculous meningitis. In our case, we should have tried to identify the causative organism in the diagnosis of pyogenic spondylitis. Especially in patients with a history of TB, the possibility of TB should always be considered. In addition, the use of antituberculous drugs may mask the presentation; therefore, biopsy or CT-guided drainage, as used in this case, should be considered for diagnostic accuracy.
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Affiliation(s)
- Ko Miyakoda
- Department of General Internal Medicine, Shonan Fujisawa Tokushukai Hospital, Fujisawa, JPN
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, JPN
| | - Ryohei Ono
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, JPN
| | - Izumi Kitagawa
- Department of General Internal Medicine, Shonan Fujisawa Tokushukai Hospital, Fujisawa, JPN
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Lee A, Chua YX. Clinics in diagnostic imaging (220). Singapore Med J 2024; 65:454-458. [PMID: 39108042 PMCID: PMC11382821 DOI: 10.4103/singaporemedj.smj-2022-171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/15/2022] [Indexed: 09/11/2024]
Affiliation(s)
- Aric Lee
- Department of Diagnostic Imaging, National University Health System, Singapore
| | - Yi-Xiu Chua
- Department of Radiology, Ng Teng Fong General Hospital, Singapore
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Hsu CK, Young WL, Wu SY. Large retroperitoneal abscess with pneumo-retroperitoneum. Asian J Surg 2024; 47:3567-3568. [PMID: 38599968 DOI: 10.1016/j.asjsur.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Affiliation(s)
- Chun-Kai Hsu
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; Department of Urology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wan-Ling Young
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Shu-Yu Wu
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; Department of Urology, School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Al-Khafaji MQ, Al-Smadi MW, Al-Khafaji MQ, Aslan S, Al-Khafaji YQ, Bagossy-Blás P, Al Nasser MH, Horváth BL, Viola Á. Evaluating Imaging Techniques for Diagnosing and Drainage Guidance of Psoas Muscle Abscess: A Systematic Review. J Clin Med 2024; 13:3199. [PMID: 38892910 PMCID: PMC11173313 DOI: 10.3390/jcm13113199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/03/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Psoas muscle abscess (PMA) is an uncommon yet severe condition characterized by diagnostic and therapeutic challenges due to its varied etiology and nonspecific symptoms. This study aimed to evaluate the effectiveness and accuracy of various imaging techniques used in the image-guided percutaneous drainage (PD) of PMA. Methods: A systematic review was conducted following the PRISMA guidelines. We searched PubMed, Google Scholar, and Science Direct for studies published in English from 1998 onwards that reported on the use of PD in treating PMA, detailing outcomes and complications. Imaging modalities guiding PD were also examined. Results: We identified 1570 articles, selecting 39 for full review. Of these, 23 met the inclusion criteria; 19 were excluded due to unspecified PMA, absence of imaging guidance for PD, or inconclusive results. Eleven studies utilized computed tomography (CT) for PD, with six also using magnetic resonance imaging (MRI). Ten studies implemented ultrasound (US)-guided PD; variations in diagnostic imaging included combinations of US, CT, and MRI. A mixed approach using both CT and US was reported in two articles. Most studies using CT-guided PD showed complete success, while outcomes varied among those using US-guided PD. No studies employed MRI-guided PD. Conclusions: This review supports a multimodal approach for psoas abscess management, using MRI for diagnosis and CT for drainage guidance. We advocate for Cone Beam CT (CBCT)-MRI fusion techniques with navigation systems to enhance treatment precision and outcomes, particularly in complex cases with challenging abscess characteristics.
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Affiliation(s)
- Murtadha Qais Al-Khafaji
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Mohammad Walid Al-Smadi
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
| | - Mustafa Qais Al-Khafaji
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Siran Aslan
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
- Department of Neurotraumatology, Semmelweis University, 1081 Budapest, Hungary
- Doctoral School of Clinical Medicine, Semmelweis University, 1083 Budapest, Hungary
| | - Yousif Qais Al-Khafaji
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Panna Bagossy-Blás
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
| | - Mohammad Hakem Al Nasser
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Bálint László Horváth
- Department of Traumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary;
| | - Árpád Viola
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
- Department of Neurotraumatology, Semmelweis University, 1081 Budapest, Hungary
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Xiang Y, He J, Bai R, Gou H, Luo F, Huang X, Zhang Z. Hounsfield Units as an Independent Predictor of Failed Percutaneous Drainage of Spinal Tuberculosis Paraspinal Abscess Under Computed Tomography Guidance. Neurospine 2023; 20:1389-1398. [PMID: 38171305 PMCID: PMC10762385 DOI: 10.14245/ns.2346820.410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/19/2023] [Accepted: 09/27/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To investigate the value of Hounsfield units (HUs) as an independent predictor of failed percutaneous drainage of spinal tuberculosis paraspinal abscess under computed tomography (CT) guidance. METHODS A retrospective analysis was conducted on 61 patients who underwent CT-guided percutaneous drainage for spinal tuberculosis paraspinal abscess between October 2017 and October 2020. Preoperative CT scans were used to measure the HUs of the abscess. Patients were categorized into successful drainage (n = 49) and failed drainage (n = 12) groups. Statistical analysis involved independent sample t-tests and chi-square tests to compare between the 2 groups. Binary logistic regression was performed to identify independent predictive factors for drainage failure. Receiver operating characteristic (ROC) curves were employed to ascertain risk factor thresholds and diagnostic performance. RESULTS Among the patients, 49 experienced successful drainage while 12 faced drainage failure. The mean HUs of abscesses in the failed drainage group were significantly higher than those in the successful drainage group (p < 0.001). ROC analysis revealed an area under the curve of 0.897 (95% confidence interval, 0.808-0.986) for predicting drainage failure based on HUs. The optimal HU cutoff value for predicting drainage failure was 22.3, with a sensitivity of 91.7% and specificity of 69.4%. CONCLUSION HUs are an independent predictor of failed percutaneous drainage of spinal tuberculosis paraspinal abscess under CT guidance. The HU value of 22.3 can be used as an initial screening threshold for predicting the success or failure of drainage.
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Affiliation(s)
- Yu Xiang
- Department of Orthopedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Jinyue He
- Department of Orthopedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Ruonan Bai
- Department of Anesthesia, Southwest Hospital, Army Medical University, Chongqing, China
| | - Huorong Gou
- Department of Orthopedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Fei Luo
- Department of Orthopedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xuequan Huang
- Department of Nuclear Medicine, Southwest Hospital, Army Medical University, Chongqing, China
| | - Zehua Zhang
- Department of Orthopedics, Southwest Hospital, Army Medical University, Chongqing, China
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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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Sah JK, Adhikari S, Sah G, Ghimire B, Singh YP. Presentation, management and outcomes of iliopsoas abscess at a University Teaching Hospital in Nepal. Innov Surg Sci 2023; 8:17-22. [PMID: 37842193 PMCID: PMC10576548 DOI: 10.1515/iss-2022-0013] [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] [Received: 05/07/2022] [Accepted: 11/21/2022] [Indexed: 10/17/2023] Open
Abstract
Objectives Iliopsoas abscess (IPA) is an uncommon clinical disease and is often missed to diagnose due to vague clinical presentation. Early treatment with drainage and appropriate antibiotic therapy is necessary before sepsis sets in and become lethal. We conducted this study to evaluate clinical features, etiology, management strategies, and outcomes in patients with IPA from a University Teaching Hospital in Nepal. Methods A retrospective analysis of 32 consecutive IPA cases managed at Tribhuvan University Teaching Hospital, Nepal for the period of January 2019 to February 2022 was carried out. Results The mean age was 42.5 ± 19.1 years (range, 19-75 years) and the male: female ratio was 2.2:1. Two-thirds or more patients presented with fever, limp, fixed flexion deformity and/or low back pain. Ultrasonography (US) was diagnostic in 27 (84.4%) patients. Eighteen (56.3%) patients had primary IPAs, and 14 (43.7%) had secondary IPAs. Thirty (93.7%) patients were managed with US guided percutaneous drainage (PCD) and 2 (6.2%) patients underwent open surgical drainage. Drainage procedures were combined with antibiotics in all patients. Pus culture showed Staphylococcus aureus growing in the majority of cases (10 of 23, 43.5%). The hospital stay was longer in patients treated via surgical drainage compared to those who received PCD: 13 days (range 12-14 days) vs. 6.6 days (range 4-13 days), respectively. Recurrence of abscess was seen in 4 (12.5%) cases and all were successfully managed via a second PCD. There was no mortality. Conclusions Varying clinical presentation of iliopsoas abscess demand a high index of suspicion for early diagnosis. Initial imaging modality in suspected case of IPA is US. US-guided PCD along with the appropriate antibiotics is a successful frontline treatment of IPAs with shorter hospital stay.
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Affiliation(s)
| | | | - Ganesh Sah
- General Surgery, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Bikal Ghimire
- General Surgery, Maharajgunj Medical Campus, Kathmandu, Nepal
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Pinto MYP, Salim J. A rare presentation of iliopsoas abscess - A case report. Int J Surg Case Rep 2023; 102:107832. [PMID: 36512883 PMCID: PMC9761371 DOI: 10.1016/j.ijscr.2022.107832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Psoas abscesses are usually confined to the psoas compartment due to its fascial attachments. However, in rare situations, the infection can locally spread beyond the psoas sheath. CASE PRESENTATION A 65-year-old patient presented with; 3 weeks of lower back and right hip pain, progressive inability to walk and one week of urinary incontinence. CT abdomen showed a right psoas abscess with pneumo-retroperitoneum extending to the right gluteus muscle, posterior compartment of the upper thigh and mediastinum. Exploration in theatre showed copious amounts of pus, visible between the fascial layers and muscles of the thigh, tracking to the level of the knee and the gluteal region. DISCUSSION Psoas abscesses are usually confined to the psoas compartment. However, in this case, it was spread to the posterior compartment of the thigh, gluteal region and pelvis with fascial necrosis and pus. Due to the extensive nature of the disease and the patient's clinical deterioration, he underwent open drainage of the psoas abscess, exploration and debridement of the posterior compartment of thigh and gluteal region with a good outcome. CONCLUSION Psoas abscesses can penetrate the psoas sheath to cause extra pelvic extension. A high index of suspicion and early imaging, if necessary, should be arranged if in doubt. Depending on the clinical severity, patients may need to be managed with open drainage and debridement than conventional CT-guided drainage.
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Affiliation(s)
| | - Joshua Salim
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia; University of Western Australia, Western Australia, Australia
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Vasigh M, Karoobi M, Montazeri M, Moradi G, Asefi H, Gilani A, Meshkati yazd SM. Isolated psoas abscess caused by Mycobacterium tuberculosis: A rare case report. Clin Case Rep 2022; 10:e05823. [PMID: 35664522 PMCID: PMC9136494 DOI: 10.1002/ccr3.5823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/03/2022] [Accepted: 04/10/2022] [Indexed: 11/19/2022] Open
Abstract
Psoas tuberculosis abscess is very rarely detected primarily without an adjacent vertebral cold abscess. Early diagnosis prevents unnecessary operations and life-threatening complications.
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Affiliation(s)
- Mahtab Vasigh
- Department of SurgeryTehran University of Medical SciencesTehranIran
| | | | - Mahnaz Montazeri
- Department of Infectious DiseasesTehran University of Medical SciencesTehranIran
| | - Golnaz Moradi
- Department of RadiologyTehran University of Medical SciencesTehranIran
| | - Hoda Asefi
- Department of RadiologyTehran University of Medical SciencesTehranIran
| | - Abolfazl Gilani
- Department of SurgeryTehran University of Medical SciencesTehranIran
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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: 8] [Impact Index Per Article: 1.6] [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: 0.4] [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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Zhang Z, Hao Y, Wang X, Zheng Z, Zhao X, Wang C, Zhang X, Zhang X. Minimally invasive surgery for paravertebral or psoas abscess with spinal tuberculosis - a long-term retrospective study of 106 cases. BMC Musculoskelet Disord 2020; 21:353. [PMID: 32505204 PMCID: PMC7276089 DOI: 10.1186/s12891-020-03344-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/12/2020] [Indexed: 12/13/2022] Open
Abstract
Background Minimally invasive surgery (MIS) is a common treatment option for paravertebral or psoas abscesses (PAs) in patients with spinal tuberculosis (ST). However, its efficacy remains controversial. The aim of the study was to evaluate the efficacy of MIS for PA with ST combined with anti-tuberculous chemotherapy. Methods A total of 106 consecutive patients who underwent MIS for ST with PA from January 2002 to Oct 2012 were reviewed. The MIS involved computed tomography (CT)-guided percutaneous catheter drainage and percutaneous catheter infusion chemotherapy. Clinical outcomes were evaluated based on the changes observed on preoperative and postoperative physical examination, inflammatory marker testing, and magnetic resonance imaging (MRI). Results The mean follow-up period was 7.21 ± 3.15 years. All surgeries were successfully completed under CT-guidance without intraoperative complications and all patients experienced immediate relief of their symptoms, which included fever and back pain. The preoperatively elevated erythrocyte sedimentation rate and C-reactive protein values returned to normal at a mean period of 3 months postoperatively. Solid bony union was observed in 106 patients and no abscesses were found on MRI examination. Conclusion MIS carries advantages in terms of less invasiveness, precise drainage, and enhanced local drug concentration. While the technique has not been fully characterized and clinically prove, its use in addition to conservative chemotherapy and open debridement and instrumental fixation may be recommended for patients with ST and PA.
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Affiliation(s)
- Zhifa Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Yongyu Hao
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xiangyu Wang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Zhirong Zheng
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xuelin Zhao
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Chunguo Wang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xifeng Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China.
| | - Xuesong Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China.
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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: 0.2] [Reference Citation Analysis] [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.
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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
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16
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Damar Ç, Özdemir M, Hekimoğlu B. İntraabdominal Apselerin Görüntüleme Eşliğinde Perkütan Drenajı. DICLE MEDICAL JOURNAL 2019. [DOI: 10.5798/dicletip.534834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gao Y, Ou Y, Quan Z, Jiang D. [Research progress of surgical treatment of thoracolumbar spinal tuberculosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:112-117. [PMID: 29806375 PMCID: PMC8414199 DOI: 10.7507/1002-1892.201705124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 12/17/2017] [Indexed: 11/03/2022]
Abstract
Objective To review the progress of surgical treatment for the thoracolumbar spinal tuberculosis. Methods The related literature of surgical treatment for the thoracolumbar spinal tuberculosis was reviewed and analyzed from the aspects such as surgical approach, fixed segments, fusion ranges, bone graft, and bone graft material research progress. Results Most scholars prefer anterior or combined posterior approach for surgical treatment of thoracic and lumbar tuberculosis because it possessed advantage of precise effectiveness. In recent years, a simple posterior surgery achieved satisfactory effectiveness. The fixation segments are mainly composed of short segments or intervertebral fixation. The interbody fusion is better for the bone graft fusion range and manner, and the bone graft materials is most satisfied with autologous iliac Cage or titanium Cage filled with autologous cancellous bone. Conclusion The perfect strategy for treating the thoracolumbar spinal tuberculosis has not yet been developed, and the personalized therapy for different patients warrants further study.
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Affiliation(s)
- Yongjian Gao
- Department of Orthopedics, the Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, P.R.China
| | - Yunsheng Ou
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010,
| | - Zhengxue Quan
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P.R.China
| | - Dianming Jiang
- Department of Orthopedics, the Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, P.R.China
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18
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Abdoulaye Diallo H, Atarraf K, My Afifi A. Attitude pseudoparalytique du nourrisson révélatrice d’un abcès du muscle psoas. ANNALES FRANCAISES DE MEDECINE D URGENCE 2017. [DOI: 10.1007/s13341-017-0748-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Abstract
Pyogenic infections of the bony spinal column and the intervertebral discs are on a steady rise in an aging western population. Despite advanced medical imaging, this clinical entity of devastating consequences if missed, still presents a diagnostic conundrum and is plagued by an unacceptably long diagnostic delay. The aim of this article is to raise awareness of the heterogeneity of spinal infections paralleling the complex structure of the spinal column and neighboring soft tissues. Emphasis is placed on the clinical presentation and management of septic facet joints and psoas muscle abscesses associated with lumbar spondylodiscitis.
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20
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Multidisciplinary Approach to an Extended Pressure Sore at the Lumbosacral Area. Arch Plast Surg 2016; 43:586-589. [PMID: 27896193 PMCID: PMC5122551 DOI: 10.5999/aps.2016.43.6.586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 09/20/2016] [Accepted: 09/28/2016] [Indexed: 11/26/2022] Open
Abstract
A pressure sore wound is often extensive or complicated by local infection involving adjacent soft tissue and bone. In this case, a regional flap after simple debridement is not adequate. Here, we present a case of an extensive pressure sore in the sacral area with deep tissue infection. A 43-year-old female patient with a complicated sore with deep tissue infection had a presacral abscess, an iliopsoas abscess, and an epidural abscess in the lumbar spine. After a multidisciplinary approach performed in stages, the infection had subsided and removal of the devitalized tissue was possible. The large soft tissue defect with significant depth was reconstructed with a free latissimus dorsi musculocutaneous flap, which was expected to act as a local barrier from vertical infection and provide tensionless skin coverage upon hip flexion. The extensive sacral sore was treated effectively without complication, and the deep tissue infection completely resolved. There was no evidence of donor site morbidity, and wheelchair ambulation was possible by a month after surgery.
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Kinoshita M, Takao S, Takechi K, Takeda Y, Miyamoto K, Yamanaka M, Akagawa Y, Iwamoto S, Osaki K, Tani H, Ohnishi N, Shirono R. Percutaneous drainage of psoas and iliopsoas muscle abscesses with a one-step technique under real-time computed tomography fluoroscopic guidance. THE JOURNAL OF MEDICAL INVESTIGATION 2016; 63:323-7. [PMID: 27644581 DOI: 10.2152/jmi.63.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
PURPOSE To evaluate the utility and safety of drainage catheter installation for psoas/iliopsoas muscle abscesses using a one-step technique under the guidance of real-time computed tomography (CT) fluoroscopy. MATERIALS AND METHODS Ten psoas or iliopsoas muscle abscesses in 7 patients that were treated with percutaneous drainage were included in this study. All drainage procedures were carried out using a one-step technique under real-time CT fluoroscopic guidance. RESULTS The drainage catheter insertion was performed successfully with the one-step technique in all lesions. Improvements in the patients' symptoms and blood test results were seen after the drainage procedure in all cases. In addition, postoperative CT scans demonstrated that the abscesses had reduced in size or disappeared in all but one patient, who was transferred to another institution while the drainage catheter was still in place. No major complications were seen in any case. CONCLUSION The one-step procedure is simple to perform. The percutaneous drainage of psoas or iliopsoas muscle abscesses with the one-step technique under real-time CT fluoroscopic guidance is accurate and safe. Moreover, compared with the two-step technique the one-step procedure results in a shorter drainage procedure and exposes the patient and operator to lower amounts of radiation. J. Med. Invest. 63: 323-327, August, 2016.
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22
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Melissano G, Civilini E, Papa M, Del Guercio R, Chiesa R. Antalgic Flexion of the Lower Limb: An Unusual Presentation of Aortoiliac Infection with Psoas Muscle Abscess. Vasc Endovascular Surg 2016; 39:287-92. [PMID: 15920659 DOI: 10.1177/153857440503900311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Psoas abscess with aortoiliac infection is rare. Patients are often symptomatic for a long time before the correct diagnosis is made. The authors report 4 cases in which the presenting symptom was an antalgic flexion of the left thigh. In 2 patients the cause was an aortic graft infection with enteric fistula; in the other 2, infection developed after transfemoral endovascular procedures. Open surgical treatment was performed in 3 cases and percutaneous drainage in 1. One surgical patient with a late diagnosis eventually died of sepsis; the other 3 are alive and well at mean follow-up of 14 months.
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Affiliation(s)
- Germano Melissano
- Chair of Vascular Surgery, Vita-Salute University, Scientific Institute H. San Raffaele, Milan, Italy.
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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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Ijaz M, Sakam S, Ashraf U, Marquez JG. Unusual Presentation of Recurrent Pyogenic Bilateral Psoas Abscess Causing Bilateral Pulmonary Embolism by Iliac Vein Compression. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:606-10. [PMID: 26356406 PMCID: PMC4572719 DOI: 10.12659/ajcr.894206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Patient: Male, 47 Final Diagnosis: Bilateral psoas abscess • acute lower extremity deep vein thrombosis • bilateral pulmonary embolism Symptoms: Progressive left leg swelling • productive cough with whitish sputum • right flank pain Medication: Antibiotics and anticoagulation Clinical Procedure: CT-guided percutaneous drain placement Specialty: Internal Medicine/Critical Care
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Affiliation(s)
- Mohsin Ijaz
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Sailaja Sakam
- Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Umair Ashraf
- Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Jose Gomez Marquez
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
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Yin XH, Zhang HQ, Hu XK, Li JS, Chen Y, Zeng KF. Treatment of pediatric spinal tuberculosis abscess with percutaneous drainage and low-dose local antituberculous therapy: a preliminary report. Childs Nerv Syst 2015; 31:1149-55. [PMID: 25863949 DOI: 10.1007/s00381-015-2694-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/30/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the outcomes of computed tomography (CT) guidance using percutaneous catheter with low-dose drainage local chemotherapy (modified PCD) and antituberculous therapy (ATT) for the treatment of spinal tuberculosis in children. METHODS Twenty-seven children suffering from spinal tuberculosis were treated with modified PCD and ATT in our institute from 2002 to 2012. We describe our treatment, which involves CT-guided percutaneous puncture and local chemotherapy (continuous low-dose (20 mL) irrigation). The patients were evaluated based on the Frankel scoring system, the kyphotic Cobb angle, and the erythrocyte sedimentation rate (ESR). RESULTS All patients were followed up for an average of 31.00 ± 13.94 months. No sinus formation was detected. All patients responded well to this treatment. The ESR values were decreased to normal at last follow-up. The neurological functions show significant improvement after operation. Preoperatively, the kyphotic angle was 22.89 ± 7.06°, and it was measured as 21.19 ± 8.73° at the last visit. CONCLUSIONS Our results showed that percutaneous intubation and low-dose irrigation under CT guidance (modified percutaneous catheter drainage (MPCD)) and ATT are easy, safe, efficient, and less invasive methods for the treatment of spinal tuberculosis in children.
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Affiliation(s)
- Xin Hua Yin
- Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, China
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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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Navarro López V. [Worldwide variations over the years in etiology of iliopsoas abscess. Reality or a selection bias?]. Med Clin (Barc) 2015; 144:259-60. [PMID: 25543226 DOI: 10.1016/j.medcli.2014.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 09/25/2014] [Accepted: 10/02/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Vicente Navarro López
- Unidad de Enfermedades Infecciosas, Hospital Universitario del Vinalopó, Elche, Alicante, España.
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Mallia AJ, Ashwood N, Arealis G, Galanopoulos I. Retroperitoneal abscess: an extra-abdominal manifestation. BMJ Case Rep 2015; 2015:bcr-2014-207437. [PMID: 25576509 DOI: 10.1136/bcr-2014-207437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Retroperitoneal abscesses are unusual occurrences with occult and insidious presentations. There is often a lack of abdominal signs, leading to delays in drainage and high mortality rates. We report a case of thigh emphysema in an 88-year-old patient with diabetes. Prior to admission the patient reported a vague 4-week history of left thigh pain and an inability to fully weight bear. She presented to our emergency department with sepsis and acute kidney impairment. An X-ray of her left femur revealed widespread gas between muscular planes. A retroperitoneal abscess involving the left renal fossa, psoas, iliacus and upper thigh muscles was revealed on an urgent CT scan. The patient was transferred to intensive care unit (ICU) and underwent an emergency drainage. Despite ICU the patient died 2 days after admission.
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Affiliation(s)
- Alvin James Mallia
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
| | - Neil Ashwood
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
| | - George Arealis
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
| | - Ilias Galanopoulos
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
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29
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Cargill T, Gupta V, Thomas P. Pyogenic iliopsoas abscess: An uncommon presentation of nonspecific leg pain. J Acute Med 2014. [DOI: 10.1016/j.jacme.2013.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Holt B, Varadarajulu S. Endoscopic ultrasound-guided pelvic abscess drainage (with video). JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 22:12-5. [PMID: 25159523 DOI: 10.1002/jhbp.150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pelvic abscesses present a serious and challenging management problem. Endoscopic ultrasound (EUS)-guided drainage provides a safe and effective minimally invasive treatment option. The likelihood of a successful outcome is dependent on appropriate patient selection, drainage technique and postoperative management. This review outlines the evidence behind and procedural steps required for EUS-guided pelvic abscess drainage.
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Affiliation(s)
- Bronte Holt
- Center for Interventional Endoscopy, Florida Hospital, 601 East Rollins Street, Orlando, FL, 32803, USA
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Hsu WH, Lai LJ, Peng KT, Lee CY. Acute pyogenic inguinal abscess from complex soft-tissue infection or intra-abdominal pathology. Surg Infect (Larchmt) 2014; 15:467-73. [PMID: 24818646 DOI: 10.1089/sur.2012.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Abscesses involving the inguinal region are uncommon as manifestations of complex soft-tissue infections or intra-abdominal pathology, and the routes by which they cause infection are usually unclear and may be overlooked. METHODS A comprehensive review of reports in the English language literature of the clinical presentations, outcomes, and causes of abscess in the inguinal/groin area requiring surgical intervention. The cases of 33 patients, including 30 patients in 27 reports in the literature and 3 patients in the Chang Gung Memorial Hospital at Chia-Yi, were reviewed to determine the ages, positions, gender, hypothesized causes, diagnostic modalities, and clinical outcomes of abscesses in the inguinal/groin area. Clinical data, laboratory examination findings, and culture results were analyzed. RESULTS Inguinal abscesses presented as tender inguinal masses that could extend from gastrointestinal, genitourinary, or retroperitoneal sites as well as being of miscellaneous origin. Most patients with such abscesses presented with fever and leukocytosis. Computed tomography provided a sensitive means for establishing the correct diagnosis and surgical plan of treatment for inguinal sbscesses. Gram-positive pathogens were associated with infections involving hip or thigh muscles and gram-negative pathogens were associated with infections involving the gastrointestinal (GI) and genitourinary (GU) tracts as well as with abscesses of the psoas muscle, Discussion: The inguinal region communicates through several routes with the peritoneal and retroperitoneal spaces as well as with the region of the thigh. The lymphatics drain from the external genitalia, inferior anal canal or perianal region, adjoining abdominal wall, and the lower extremities. Evaluation of a patient with inguinal abscess and with signs of infection should include computed tomography (CT) to elucidate the extent of infectious disease. Information obtained from CT is important in guiding the prescription of antibiotics and surgical planning for the treatment of inguinal abscesses. CONCLUSIONS Computed tomography is helpful in diagnosing inguinal abscess and determining the extent of infection. In patients presenting with inguinal abscess. Early recognition of its origin can facilitate further surgical planning and possibly improve the outcome.
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Affiliation(s)
- Wei-Hsiu Hsu
- 1 Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia-Yi , Chia Yi, Taiwan
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Kodama K, Takase Y, Motoi I, Mizuno H, Goshima K, Sawaguchi T. Retroperitoneoscopic drainage of bilateral psoas abscesses under intraoperative laparoscopic ultrasound guidance. Asian J Endosc Surg 2014; 7:179-81. [PMID: 24754884 DOI: 10.1111/ases.12091] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 12/05/2013] [Accepted: 12/26/2013] [Indexed: 12/01/2022]
Abstract
Despite improved diagnostic modalities for psoas abscesses, the optimum management strategy is not uniform. A 67-year-old man presented with bilateral psoas abscesses secondary to L1-L2 pyogenic discitis. On contrast-enhanced CT, the largest of these abscesses measured 13 × 14 × 33 mm on the right. The patient developed sepsis caused by Klebsiella pneumonia. There were no signs of improvement after 3 weeks of systematic antibiotic administration. We performed surgical drainage of bilateral psoas abscesses by retroperitoneoscopy. Intraoperative laparoscopic ultrasound was useful to determine abscess location in the muscles prior to drainage and confirm no residual abscesses after drainage. The patient was afebrile 3 days later, and his clinical symptoms resolved. Retroperitoneoscopic drainage may represent a feasible minimally invasive therapeutic option for psoas abscess, and intraoperative laparoscopic ultrasound has the potential to increase the safety and efficacy of this surgical procedure.
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Affiliation(s)
- Koichi Kodama
- Department of Urology, Toyama City Hospital, Toyama, Japan
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Retroperitoneal abscesses in two western lowland gorillas (Gorilla gorilla gorilla). J Zoo Wildl Med 2014; 45:179-83. [PMID: 24712182 DOI: 10.1638/2013-0118r1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This report describes two cases of retroperitoneal abscesses in female western lowland gorillas (Gorilla gorilla gorilla). Clinical symptoms included perivulvar discharge, lameness, hindlimb paresis, and general malaise. Retroperitoneal abscesses should be considered as part of a complete differential list in female gorillas with similar clinical signs.
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Asseban M, Qarro A, Bazine K, Beddouch A, Lezrek M, Ammani A, Alami M. Drainage percutané de l’abcès du psoas: Notre expérience et revue de la littérature. Percutaneous drainage of psoas abscess. Our experience and literature review. AFRICAN JOURNAL OF UROLOGY 2014. [DOI: 10.1016/j.afju.2013.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Dave BR, Kurupati RB, Shah D, Degulamadi D, Borgohain N, Krishnan A. Outcome of percutaneous continuous drainage of psoas abscess: A clinically guided technique. Indian J Orthop 2014; 48:67-73. [PMID: 24600066 PMCID: PMC3931156 DOI: 10.4103/0019-5413.125506] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Percutaneous aspiration of abscesses under ultrasonography (USG) and computer tomography (CT) scan has been well described. With recurrence rate reported as high as 66%. The open drainage and percutaneous continuous drainage (PCD) has reduced the recurrence rate. The disadvantage of PCD under CT is radiation hazard and problems of asepsis. Hence a technique of clinically guided percutaneous continuous drainage of the psoas abscess without real-time imaging overcomes these problems. We describe clinically guided PCD of psoas abscess and its outcome. MATERIALS AND METHODS Twenty-nine patients with dorsolumbar spondylodiscitis without gross neural deficit with psoas abscess of size >5 cm were selected for PCD. It was done as a day care procedure under local anesthesia. Sequentially, aspiration followed by guide pin-guided trocar and catheter insertion was done without image guidance. Culture sensitivity was done and chemotherapy initiated and catheter kept till the drainage was <10 ml for 48 hours. Outcome assessment was done with relief of pain, successful abscess drainage and ODI (Oswestry Disability Index) score at 2 years. RESULTS PCD was successful in all cases. Back and radicular pain improved in all cases. Average procedure time was 24.30 minutes, drain output was 234.40 ml, and the drainage duration was 7.90 days. One patient required surgical stabilisation due to progression of the spondylodiscitis resulting in instability inspite of successful drainage of abscess. Problems with the procedure were noticed in six patients. Multiple attempts (n = 2), persistent discharge (n = 1) for 2 weeks, blocked catheter (n = 2) and catheter pull out (n = 1) occurred with no effect on the outcome. The average ODI score improved from 62.47 to 5.51 at 2 years. CONCLUSIONS Clinically guided PCD is an efficient, safe and easy procedure in drainage of psoas abscess.
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Affiliation(s)
- Bharat R Dave
- Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India
| | - Ranganatha Babu Kurupati
- Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India
| | - Dipak Shah
- Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India
| | - Devanand Degulamadi
- Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India
| | - Nitu Borgohain
- Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India
| | - Ajay Krishnan
- Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India
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Hsieh MS, Huang SC, Loh EW, Tsai CA, Hung YY, Tsan YT, Huang JA, Wang LM, Hu SY. Features and treatment modality of iliopsoas abscess and its outcome: a 6-year hospital-based study. BMC Infect Dis 2013; 13:578. [PMID: 24321123 PMCID: PMC3878923 DOI: 10.1186/1471-2334-13-578] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 11/27/2013] [Indexed: 12/17/2022] Open
Abstract
Background Percutaneous drainage (PCD) and surgical intervention are two primary treatment options for iliopsoas abscess (IPA). However, there is currently no consensus on when to use PCD or surgical intervention, especially in patients with gas-forming IPA. This study compared the characteristics of patients with gas-forming and non-gas forming IPA and their mortality rates under different treatment modalities. An algorithm for selecting appropriate treatment for IPA patients is proposed based on our findings. Methods Eighty-eight IPA patients between July 2007 and February 2013 were enrolled in this retrospective study. Patients < 18 years of age or with an incomplete course of treatment were excluded. Demographic information, clinical characteristics, and outcomes of different treatment approaches were compared between gas-forming IPA and non-gas forming IPA patients. Results Among the 88 enrolled patients, 27 (31%) had gas-forming IPA and 61 (69%) had non-gas forming IPA. The overall intra-hospital mortality rate was 25%. The gas-forming IPA group had a higher intra-hospital mortality rate (12/27, 44.0%) than the non-gas forming IPA group (10/61, 16.4%) (P < 0.001). Only 2 of the 13 patients in the gas-forming IPA group initially accepting PCD had a good outcome (success rate = 15.4%). Three of the 11 IPA patients with failed initial PCD expired, and 8 of the 11 patients with failed initial PCD accepted salvage operation, of whom 5 survived. Seven of the 8 gas-forming IPA patients accepting primary surgical intervention survived (success rate = 87.5%). Only 1 of the 6 gas-forming IPA patients who accepted antibiotics alone, without PCD or surgical intervention, survived (success rate = 16.7%). In the non-gas forming IPA group, 23 of 61 patients initially accepted PCD, which was successful in 17 patients (73.9%). The success rate of PCD was much higher in the non-gas forming group than in the gas-forming group (P <0.01). Conclusions Based on the high failure rate of PCD and the high success rate of surgical intervention in our samples, we recommend early surgical intervention with appropriate antibiotic treatment for the patients with gas-forming IPA. Either PCD or primary surgical intervention is a suitable treatment for patients with non-gas forming IPA.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
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Postoperative fluid collections after colon resection: the utility of clinical assessment. Am J Surg 2013; 206:551-4. [DOI: 10.1016/j.amjsurg.2013.01.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 12/17/2012] [Accepted: 01/17/2013] [Indexed: 11/17/2022]
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Hsu WH, Lee CY, Lai LJ, Huang TY, Peng KT. The role of cross sectional imaging in the management of acute pyogenic inguinal abscess - extrapelvic versus intrapelvic origin. BMC Infect Dis 2013; 13:155. [PMID: 23537455 PMCID: PMC3639101 DOI: 10.1186/1471-2334-13-155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 03/22/2013] [Indexed: 11/16/2022] Open
Abstract
Background Abscesses involving the inguinal region as manifestations of complex soft-tissue infections are rare, and the infectious route is usually unclear. The purpose of this study was to ascertain the importance of imaging study and whether the clinical presentations differ between the extrapelvic and intrapelvic origin. Methods Patients who presented with inguinal abscess between January 2003 and December 2010 were evaluated retrospectively. All patients received broad-spectrum antibiotic therapy and debridement. Imaging studies, including computed tomography or magnetic resonance imaging, were performed in all patients to elucidate the origin and extent of infectious disease, and the results were reviewed. Clinical data, laboratory examination findings, and culture results were analyzed. Results Twenty-eight patients were enrolled in the study: 13 patients whose infections were of extrapelvic origin (Group 1) and 15 patients of intrapelvic origin (Group 2). Imaging studies yielded information that helped guiding the treatment. Gram-positive coccus infection was more frequent in Group 1 (p < 0.001), while mixed pathogen and anaerobic bacterial infection were more frequent in Group 2 (p = 0.002 and p = 0.006, respectively). Group 2 had a higher incidence of history of malignancy and chronic renal failure (p = 0.044 and p = 0.038, respectively). Conclusions Computed tomography and magnetic resonance imaging are helpful in diagnosing cases of inguinal abscess and determining the extent of infection. In patients presenting with acute pyogenic inguinal abscess, a higher prevalence of chronic renal failure and history of malignancy were found in those with an intrapelvic, as compared with an extrapelvic, origin of infection.
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Affiliation(s)
- Wei-Hsiu Hsu
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia Yi, 6 West Section Chia Pu Road, Chia Yi Hsien 613, Taiwan.
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Duani H, Nunes VRT, Assumpção AB, Saraiva ISB, Rosa RM, Neiva AM, Pedroso ÊRP. Bilateral paracoccidioidomycotic iliopsoas abscess associated with ileo-colonic lesion. Rev Soc Bras Med Trop 2012; 45:649-51. [DOI: 10.1590/s0037-86822012000500021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 12/14/2011] [Indexed: 11/22/2022] Open
Abstract
This case report shows the clinical development of a patient with systemic paracoccidioidomycosis presenting with lymphatic-intestinalmanifestation. The patient initially had a substantial clinical improvement but had a recrudescence after six months of sulfamethoxazoletrimethoprim oral treatment, with the emergence of feverish syndrome, lumbar pain, and intermittent claudication, characterizing a bilateral iliopsoas muscle abscess, necessitating clinicosurgical therapeutics.
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Büyükbebeci O, Seçkiner I, Karslı B, Karakurum G, Başkonuş I, Bilge O, Kacira BK. Retroperitoneoscopic drainage of complicated psoas abscesses in patients with tuberculous lumbar spondylitis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21:470-3. [PMID: 22015814 DOI: 10.1007/s00586-011-2049-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 08/17/2011] [Accepted: 10/09/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Nowadays, endoscopic techniques are widely used in surgical procedures. Retroperitoneoscopy has been an extremely valuable tool for a wide variety of urologic disorders, whereas, it has limited use in orthopedic procedures. METHODS We performed retroperitoneoscopic drainage (in combination with medical treatment) of complicated psoas abscess on 12 patients with tuberculous spondylitis. All the procedures were done under general anesthesia and in the lateral decubitus position. Psoas abscess was evacuated during procedure, and postoperatively, drainage was continued through a large silastic tube. The definitive diagnosis and the treatment were made based on the results of culture-antibiogram and PCR testing. RESULTS Complete clinical and radiologic remission was observed in all patients in 3-6 months. The complication was not observed in any case postoperatively. CONCLUSIONS Retroperitoneoscopic drainage of psoas abscesses gains advantages in terms of rapid recovery, minimal invasiveness, absence of radiation, and shorter hospital stay. This procedure can be used not only for cold abscesses but also for other pathologies of lumbar vertebral area.
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Affiliation(s)
- Orhan Büyükbebeci
- Department of Orthopedic Surgery, Meram Faculty of Medicine, Selcuk University, Meram, Konya, Turkey.
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García Montero P, Laguna del Estal P, López-Cano Gómez M, Castañeda Pastor A, Gil Navarro M. [Pyogenic and tuberculous abscesses of the psoas muscle]. Rev Clin Esp 2011; 211:572-8. [PMID: 21982042 DOI: 10.1016/j.rce.2011.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 07/05/2011] [Accepted: 07/24/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe the clinical characteristics of patients with abscess on the psoas muscle (PA) and to identify the possible differences existing between pyogenic and tuberculous etiologies. PATIENTS AND METHODS A retrospective review of patients diagnosed of PA in one hospital was conducted (1983-2009). Two groups were established, that is pyogenic and tuberculous, and the clinical findings, analyses and evolution were compared. RESULTS Thirty PA were included, 83% pyogenic and 17% tuberculous, average age 53 years. On 9 occasions, 30% were primary and on 21 occasions, 70% secondary (to skeletal pathology in 8, to urological in 8 and to gastrointestinal in 8). No clinical differences were observed between both groups. Pyogenic and tuberculous etiologies were differentiated analytically through leukocyte values (13,871 vs. 8,560/mm(3), p=0.018), hemoglobin (11 vs. 14 g/dL, p=0.008) and erythrocyte sedimentation rate (ESR) (108 vs. 17 mm/h, p<0.0001). Abscesses were diagnosed by computed tomography (CT) in 29 patients (97%) and by magnetic resonance in 1 (3%), both with a diagnostic sensitivity of 100%, as opposed to 50% for ultrasound scanning. Left laterality was less frequent in pyogenic abscesses (44% vs. 100%, p=0.031). The blood cultures were positive in 22% and abscess pus culture in 82%. Gram negative bacilli, Streptococcus spp. and S. aureus were the most frequent isolations. A total of 67% were drained: transcutaneously 50%, surgically 13% and both techniques 3%. Two patients died (7%), both with pyogenic abscess. CONCLUSIONS Secondary pyogenic abscesses constitute the most frequent PA group. CT is the diagnostic procedure of choice. Leukocytosis, anemia, raised ESR and right laterality suggest pyogenic etiology. Transcutaneous drainage is substituting surgical drainage and also makes it possible to obtain diagnostic samples.
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Affiliation(s)
- P García Montero
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España.
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Lim CS, Brzeski M, Yapanis M. A challenging case of bilateral iliopsoas abscess. Surg Infect (Larchmt) 2010; 12:69-72. [PMID: 21091188 DOI: 10.1089/sur.2009.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Bilateral iliopsoas abscess is very rare and has never been reported in cases of aortic graft infections. To date, only cases of unilateral abscess have been reported in association with aortic graft infection, and even these are uncommon. METHODS Case report and literature review. RESULTS We present the first report of an infected abdominal aortic graft, secondary to an ileal perforation, in a 76-year-old woman presenting with bilateral iliopsoas abscess. The presence of lumbar spondylodiscitis initially led us to suspect this as the primary cause of the abscess. Hence, she was treated initially with drainage of the abscess, percutaneously and surgically. This proved to be unsuccessful. A laparotomy, excision of the aortic graft, and in situ revascularization with a femoral venous conduit was performed subsequently. The bilateral iliopsoas abscess was found to be caused by a perforation of the ileum. Despite the surgery, the patient finally succumbed. CONCLUSIONS Bilateral iliopsoas abscess secondary to infected aortic graft is extremely rare and challenging. Drainage of the abscess, percutaneously or surgically, and excision of graft with or without revascularization must be considered carefully based on the individual case.
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Kuo CC, Ku SC, Wang JT, Tsai CW, Wu VC, Chou WC. Psoas abscess caused by non-typhoid Salmonella in a patient with severe aplastic anemia. Yonsei Med J 2010; 51:472-4. [PMID: 20376908 PMCID: PMC2852811 DOI: 10.3349/ymj.2010.51.3.472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The clinical spectrum of infections caused by non-typhoid Salmonella spp. includes gastroenteritis, enteric fever, bacteremia, and extraintestinal localized complications, especially in immunocompromised hosts. Here we report a patient with severe aplastic anemia developing left iliopsoas abscess caused by non-typhoid Salmonella (NTS), which was successfully treated by prolonged antibiotic treatment and repeated debridement. Our data indicate that aplastic anemia is a risk factor for infection caused by NTS.
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Affiliation(s)
- Chin-Chi Kuo
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Shih-Chi Ku
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Wei Tsai
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chien Chou
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Charalampopoulos A, Macheras A, Charalabopoulos A, Fotiadis C, Charalabopoulos K. Iliopsoas abscesses: diagnostic, aetiologic and therapeutic approach in five patients with a literature review. Scand J Gastroenterol 2009; 44:594-9. [PMID: 19225988 DOI: 10.1080/00365520902745054] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Iliopsoas abscess is a relatively rare disease. Many cases present atypical clinical characteristics. Iliopsoas abscess can be primary or secondary to gastrointestinal and genitourinary infections and in developed countries most of these abscesses are of non-tuberculous aetiology. A high index of clinical suspicion, the past and recent history of the patient and imaging studies can be helpful in diagnosing the disease. Early treatment with drainage, surgery or appropriate antibiotic therapy is necessary before the sepsis becomes lethal. The purpose of the study was to present five cases with iliopsoas abscesses based on the rarity of this clinical entity. MATERIAL AND METHODS Five cases with iliopsoas abscess, treated during the past 10 years were analysed retrospectively, with emphasis on the diagnostic and therapeutic approach to the disease. RESULTS Three out of five cases were primary abscesses; one was of tuberculous aetiology and one secondary to bowel perforation due to a tumour. Staphylococcus aureus was the main bacterium in primary abscesses. Percutaneous drainage with administration of appropriate antibiotics was the main treatment. The secondary psoas abscess was treated successfully with surgery. Owing to long-standing septic and atypical symptoms before admission, one case had a lethal course, despite the early hospital diagnosis and treatment. CONCLUSIONS The aetiology of iliopsoas abscess can vary, disposing to a high index of suspicion. Imaging studies can confirm the diagnosis early, and differentiation between primary and secondary type determines the most appropriate kind of treatment.
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Affiliation(s)
- Anestis Charalampopoulos
- Third Department of General Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
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Pieri S, Agresti P, Altieri AM, Ialongo P, Cortese A, Alma MG, de' Medici L. Percutaneous management of complications of tuberculous spondylodiscitis: short- to medium-term results. Radiol Med 2009; 114:984-95. [PMID: 19554419 DOI: 10.1007/s11547-009-0425-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Accepted: 11/12/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE Psoas abscesses are the most frequent complication of tuberculosis with skeletal involvement. The aim of this paper is to report our experience with the systematic application of percutaneous drainage to tuberculous psoas abscesses. MATERIALS AND METHODS Between January 1997 and December 2005, 23 patients (14 men and nine women; age range 21-48 years), after a previous study with computed tomography (CT) and/or magnetic resonance (MR) imaging, underwent percutaneous drainage of a tuberculous fluid collection in the psoas muscles. Follow-up consisted of monthly clinical and laboratory assessment, and plain chest radiography and spinal CT every 6-12 months. RESULTS Spondylodiscitis involved the thoracolumbar spine. Fluid collections were bilateral in 14 cases and communicating in ten of these. Maximum transverse diameter was 7 cm, whereas longitudinal diameter was 14 cm. Placement of the drainage catheter was successful in all cases, and the catheter was left in place for 5-36 (mean 18.4) days. Symptom regression occurred immediately after drainage of the fluid collection. The drainage procedure was curative in 100% of cases. Dislodgement of the drainage catheter occurred in two cases as a result of excessive traction during dressing removal. CONCLUSIONS A serious complication of bone tuberculosis, psoas abscesses, can be effectively treated by percutaneous drainage, leading to immediate pain resolution. The drainage catheter requires daily monitoring to identify when it can be safely removed without risk of recurrence.
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Affiliation(s)
- S Pieri
- Radiologia Vascolare ed Interventistica, Rome, Italy.
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López VN, Ramos JM, Meseguer V, Pérez Arellano JL, Serrano R, Ordóñez MAG, Peralta G, Boix V, Pardo J, Conde A, Salgado F, Gutiérrez F. Microbiology and outcome of iliopsoas abscess in 124 patients. Medicine (Baltimore) 2009; 88:120-130. [PMID: 19282703 DOI: 10.1097/md.0b013e31819d2748] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
To describe the microbiology and outcome of iliopsoas abscess (IPA) in a large case series, we analyzed 124 cases of IPA collected from 1990 through 2004 in 11 hospitals in Spain. Twenty-seven (21.8%) patients had primary and 97 (78.2%) had secondary IPA. The main sources of infection were bone (50.5%), gastrointestinal tract (24.7%), and urinary tract (17.5%). A definitive microbial diagnosis was achieved in 93 (75%) cases. Abscess culture was the most frequent procedure leading to microbial diagnosis, followed by blood cultures. Staphylococcus aureus, Escherichia coli, and Bacteroides species were the most frequent microbial causes: S. aureus was the most common organism in patients with primary abscesses (42.9%) and with abscesses of skeletal origin (35.2%), whereas E. coli was the leading organism in those with abscesses of urinary (61.5%) and gastrointestinal (42.1%) tracts. Mycobacterium tuberculosis was found in 15 patients, 4 of them associated with human immunodeficiency virus (HIV) infection. Twenty (21.5%) cases had polymicrobial infections; these were more common among patients with abscesses of gastrointestinal origin. Information on clinical outcome was available for 120 patients; 19 (15.8%) had a relapse and 6 (5%) died due to complications related to the IPA. Patients who died were older and more likely to have bacteremia and E. coli isolated from cultures. In conclusion, secondary IPA is more prevalent than primary IPA. Among those with secondary IPA, most abscesses are secondary to a skeletal source. A bacterial etiology can be identified in most cases. The overall prognosis of patients with this condition is good.
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Affiliation(s)
- Vicente Navarro López
- From the Infectious Diseases Unit (VNL), Internal Medicine Department, Hospital de Torrevieja, Alicante; Infectious Diseases Unit (JMR, FG), Internal Medicine Department, Hospital General Universitario de Elche, Alicante; Internal Medicine Department (VM), Hospital General de Albacete, Albacete; Infectious Diseases Unit (JLPA), Internal Medicine Department, Hospital Insular de Gran Canaria, Gran Canaria; Internal Medicine Department (RS), Hospital del Henares, Coslada, Madrid; Internal Medicine Department (MAGO), Hospital de Antequera, Málaga; Internal Medicine Unit (GP), Hospital Sierrallana Torrelavega, Cantabria; Infectious Diseases Unit (VB), Hospital General de Alicante, Alicante; Infectious Diseases Unit (JP), Hospital Universitario de Salamanca, Salamanca; Internal Medicine Department (AC), Hospital Dr Negrin, Gran Canaria; Internal Medicine Department (FS), Hospital Serranía de Ronda, Malaga, Spain
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Yamagami T, Terayama K, Yoshimatsu R, Matsumoto T, Miura H, Nishimura T. Percutaneous drainage of psoas abscess under real-time computed tomography fluoroscopic guidance. Skeletal Radiol 2009; 38:275-80. [PMID: 19002684 DOI: 10.1007/s00256-008-0608-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 08/24/2008] [Accepted: 10/05/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The goal of our study was to determine the usefulness of percutaneous abscess drainage under guidance of computed tomography (CT) fluoroscopy. MATERIALS AND METHODS Our subjects were 21 patients (seven women, 14 men; mean age 64 years; age range 30-87 years) who had undergone percutaneous drainage of 26 psoas abscess lesions under CT fluoroscopic guidance between May 2001 and January 2008. Drainage methods involved a needle puncture, insertion of a guidewire, serial dilations, and the exchange of the needle with a drainage tube. The procedures were guided by use of a helical CT scanner that provided real-time fluoroscopic reconstruction. RESULTS Percutaneous drainage under real-time CT fluoroscopic guidance was successfully performed in every procedure. Use of real-time CT fluoroscopy allowed rapid assessment of needle, guidewire, and catheter placement. No patient had serious complications related to the drainage procedure. The mean procedure time required to drain one lesion was 35.6 +/- 13.6 min. Mean period after the drainage procedure until complete disappearance of the abscess as confirmed by CT was 12.4 +/- 10.0 days (range 3-46 days). CONCLUSION CT fluoroscopy is useful in achieving accurate and safe drainage of abnormal psoas fluid collections.
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Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto 602-8566, Japan.
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Multiple pyogenic spondylodiscitis with bilateral psoas abscesses accompanying osteomyelitis of lateral malleolus - a case report -. Asian Spine J 2008; 2:102-5. [PMID: 20404964 PMCID: PMC2852090 DOI: 10.4184/asj.2008.2.2.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Revised: 10/01/2008] [Accepted: 10/02/2008] [Indexed: 11/08/2022] Open
Abstract
A psoas abscess is a potentially life-threatening infection. Multiple pyogenic spondylodiscitis with bilateral psoas abscesses accompanying an osteomyelitis of the lateral malleolus is an extremely rare event. We present our experience with needle aspiration for the treatment of osteomyelitis of the lateral malleolus and CT-guided percutaneous catheter drainage for a psoas abscess in an elderly patient. Both infections were completely resolved without recurrence. A psoas abscess should be included in the differential diagnosis of a patient with low back pain during musculoskeletal infection. Percutaneous needle aspiration or CT-guided percutaneous catheter drainage is an effective method for treating certain musculoskeletal infections.
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