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PubMed1993

Percutaneous catheter drainage of tuberculous psoas abscesses.

Six patients with 7 tuberculous psoas or ilio-psoas abscesses were treated by CT-guided catheter drainage and chemotherapy. The abscesses (5 unilateral and 1 bilateral) were completely drained using a posterior or lateral approach. The abscess volume was 70 to 700 ml (mean 300 ml) and the duration of drainage 5 to 11 days (mean 7 days). Immediate local symptomatic improvement was achieved in all patients, and there were no procedural complications. CT follow-up at 3 to 9 months showed normalization in 5 patients, 2 of whom are still on medical therapy. One patient, who did not take the medication regularly, had a recurrent abscess requiring new catheter drainage after which the fluid collection disappeared. Percutaneous drainage represents an efficient and attractive alternative to surgical drainage as a supplement to medical therapy in the management of patients with large tuberculous psoas abscesses.

Adult↗
PubMed1983

Ilio-psoas abscess in Crohn's disease.

We encountered 12 patients with psoas abscess in a two-year period. Of these, four were due to Crohn's disease making this the most important single cause of such abscesses in our series. Psoas abscess may be the presenting complaint in Crohn's disease and it should be considered as a possible cause of any psoas abscess from which enteric organisms are cultured.

Adult↗
PubMed1995

Salmonella psoas abscess--a case report.

The clinical presentation of psoas abscess is often non-specific and insidious that may mislead the diagnosis and treatment. The abscess often extends beyond the retroperitoneum and pelvis before its diagnosis, and leads to serious complications. Many diseases have the similar signs and symptoms and must be ruled out. Computed tomogram is the most useful and reliable diagnostic tool. Only a few cases of salmonella psoas abscess were reported in the literature, and were usually associated with spinal osteomyelitis or septic hip. We present a case of salmonella psoas abscess in a patient with diabetes mellitus. The patient had the history of cholecystitis with sepsis due to salmonella infection 4 years before and cholecystectomy had been done. No associated lesion was found to be associated with the abscess, and we believed the abscess being the result of recurrent bacteremic attack. High index of suspicion, early diagnosis, adequate drainage and effective antibiotic treatment are the key points in managing the disease.

Aged↗
PubMed2006

Psoas abscess secondary to Pott's disease--an unusual presentation in a young child.

Psoas abscess in neonates and infants are rare. Primary psoas abscesses are said to be more common in young children. Limping, fever and abdominal pain has been described to be the way psoas abscesses usually present. The authors describe the unusual presentation and successful treatment of a young child with a unilateral psoas abscess secondary to advanced spondylodiscitis.

Antitubercular Agents↗
PubMed2002

Successful medical management of multifocal psoas abscess following cesarean section: report of a case and review of the literature.

The psoas abscess is a rare complication in obstetric and gynaecology. Two types of psoas abscess are recognized. The primary psoas abscess is generally following haematogenous dissemination of an infectious agent and the source is usually occult. The most frequently isolated pathogen is Staphylococcus aureus. On the other hand, the secondary abscess is the result of local extension of an infectious process near the psoas muscle. We report the case of a patient who develops a bacteremia from an infected cesarean section wound. The complications were thigh and psoas abscesses with left sacroiliitis. Medical management with prolonged antibiotherapy permit clinical, biological and radiological improvement. Although it required a long hospital stay, medical treatment alone was effective. More experience is required to determine which therapeutic option: medical treatment and/or surgery, is the best choice for this type of complication.

Adult↗
PubMed2004

Psoas abscess: a rare complication of Crohn's disease.

UNLABELLED: Psoas abscess is a rare complication of Crohn's disease. METHODS AND MATERIALS: We evaluated the incidence of psoas abscess on 312 patients with Crohn's disease, seen at our institution between 1992-2001. RESULTS: We encountered three cases of psoas abscess (0.9%). One patient was managed with ileocolic resection and immediate anastomosis, while in two patients a percutaneous drainage was first performed and then, after 12 days of total parenteral nutrition, a resection of the diseased bowel with immediate reconstruction was carried out. CONCLUSIONS: A correction of the nutritional deficiencies is mandatory. Percutaneous computed-tomography guided drainage of the abscess with intestinal resection with immediate anastomosis, performed after a parenteral hyperalimentation, should be the method of choice in the management of such patients.

Adolescent↗
PubMed1994

[CT-guided percutaneous drainage in the management of psoas abscesses].

The authors review their first experiences in Hungary with the CT guided percutaneous catheter treatment of psoas abscesses. Diagnostic aspiration from abscess was performed in one patient. Percutaneous catheter drainage of psoas abscess were performed in 4 patients. There were 4 patients with unilateral and 1 patient with bilateral psoas abscess. 4 patients had tuberculous spondylodiscitis, 1 patient had staphylococcal vertebral osteomyelitis. One patient following diagnostic aspiration was successfully treated with antituberculoutic drugs. All patient treated with percutaneous catheter drainage received medical antituberculoutic or antibiotic therapy and showed excellent clinical and radiological results. There was no complication and there was no need to open surgical drainage in this series. CT guided aspiration is a valuable tool in the diagnosis of psoas abscesses as well as in the identification of the exact abscess etiology. Percutaneous drainage represents an efficient and attractive alternative to open surgical drainage in the treatment of psoas abscesses.

Aged↗
PubMed2006

Two cases of pott disease associated with bilateral psoas abscesses: case report.

STUDY DESIGN: Two case reports and a literature review of spinal osteomyelitis with bilateral psoas abscesses secondary to Mycobacterium tuberculosis. OBJECTIVE: Describe the presentation, diagnosis, treatment, and outcome of spinal tuberculosis (i.e., Pott disease). SUMMARY OF BACKGROUND DATA: Pott disease is a well-known condition in unindustrialized countries causing multiple spinal deformities in children. However, its association with bilateral psoas abscesses in adults with minimal risk factors is not commonly recognized in industrialized countries. METHODS: There are 2 adult cases of Pott disease with psoas abscesses presented, and the relevant literature is reviewed. Plain spine radiographs, spine magnetic resonance imaging (MRI), routine bacterial and acid-fast bacilli cultures of infected material, and other diagnostic testing for M. tuberculosis were performed. RESULTS: Plain radiographs and MRI of the spine showed vertebral osteomyelitis with compression fractures, and MRI also revealed bilateral psoas abscesses. Acid-fast bacilli culture and other M. tuberculosis diagnostic testing of psoas abscess specimens confirmed the diagnosis of M. tuberculosis. CONCLUSION: Although spinal osteomyelitis with psoas abscess is classically associated with Staphylococcus aureus infection, Pott disease should be considered in this clinical setting, and risk factor assessment and testing for tuberculosis should be performed.

Aged, 80 and over↗
PubMed1995

Latent solitary tuberculous psoas abscess 52 years after healed thoracolumbar tuberculous spondylitis.

STUDY DESIGN: This study reports on an extremely rare case of tuberculous psoas abscess and describes the mode of diagnosis and treatment. OBJECTIVE: This patient is presented to emphasize that cases of solitary psoas abscess resulting from tuberculosis exist today. SUMMARY OF BACKGROUND DATA: No recent cases of latent solitary tuberculous psoas abscess have been reported, to the authors' knowledge. METHODS: A tuberculous psoas abscess associated with fistula to the greater trochanter may remain dormant for years after tuberculous spondylitis has healed, as a distinct entity without concomitant active bone infection. In our 58-year-old female patient, the diagnosis of a psoas abscess was greatly aided by the "three pass" technetium bone scan and computed tomography, but the anamnesis also was important. RESULTS: Anti-tuberculosis medication (streptomycin, aminosalicylic, and isoniazid) combined with open drainage, curettage of the psoas, and simultaneous revision of the fistula eradicated the disease, making the course of the disease uneventful until the 5-year follow-up evaluation. CONCLUSIONS: Orthopedic surgeons must be aware of the rare, delayed appearance of a solitary psoas abscess after tuberculous spondylitis.

Female↗
PubMed2001

Psoas abscess and cellulitis of the right gluteal region resulting from carcinoma of the cecum.

Although retroperitoneal or psoas abscess is an unusual clinical problem, the insidious and occult characteristics of this abscess sometimes cause diagnostic delays, resulting in considerably high morbidity and mortality. In particular, psoas abscess caused by perforated colon carcinoma is uncommon. We report a case of psoas abscess caused by a carcinoma of the cecum. A 72-year-old Japanese woman was admitted to our hospital, with pain in the right groin and buttock. The pain had appeared 6 months before admission, and the symptoms had then been relieved by oral antibiotics. On March 25, 1999, inflammatory signs in the right buttock indicated localized cellulitis, and incision and drainage was performed at a local hospital. The patient was referred to our hospital on the same day. On admission to our hospital, computed tomography (CT) scan revealed a thick right-sided colonic wall and enlargement of the right ileopsoas muscle. Barium enema and colonofiberscopy revealed an ulcerated tumor occupying the entire circumference of the cecum. A retroperitoneal abscess and fistula had been formed by the retroperitoneal perforation of cecum carcinoma: surgical resection was performed after remission of the local inflammatory signs. Operative findings indicated that the cancerous lesion and its surrounding tissues were firmly attached to the right iliopsoas and major psoas muscle, and en-bloc resection, including adjacent muscular tissue, was performed. The fact that carcinoma of the colon could be a cause of psoas abscess and cellulitis in the gluteal region should be considered when an unexplained psoas abscess is diagnosed.

Adenocarcinoma↗
PubMed1999

Primary psoas abscess due to Fusobacterium nucleatum.

A case of primary pyogenic psoas abscess due to Fusobacterium nucleatum is described. Clinicians must maintain a high index of clinical suspicion for the diagnosis of psoas abscess. Although Staphylococcus aureus accounts for most cases of primary psoas abscess, this report emphasizes the importance of bacteriological confirmation of the microorganism involved.

Female↗
PubMed1996

[A case of psoas abscess associated in the elderly].

A case of psoas abscess associated with diabetes mellitus in the elderly is reported. A 81-year-old male who had been followed for cerebral thrombosis, diabetes mellitus and basal cell carcinoma was admitted to our hospital because of high fever. Leukocytosis, a positive CRP test and pyuria were seen. Proteus mirabilis and Escherichia coli were detected by urine and blood culture, respectively. He was treated with antibiotic therapy for urinary tract infection and sepsis. After starting treatment, a low grade fever continued. On the twenty first hospital day he developed pyrexia again, and a large abscess was demonstrated in the right psoas muscle by pelvic couputed tomography. The abscess was drained and a specimen from it yielded E. coli on culture. Treatment with antibiotics and drainage resulted in symptomatic improvement. In Japan, 82 cases of psoas abscess have been reported from 1990 to 1994. Four cases of these reports were above eighty years old. The experience with this case indicates the necessity of adequate care in cases of elderly diabetes complicated by psoas abscess.

Aged↗
PubMed1986

Non-tuberculous psoas abscess.

Non-tuberculous psoas abscess is associated with a wide variety of conditions in addition to its well known association with infection in the lumbar spine. Computed tomography (CT) enables the diagnosis to be made at a relatively early stage when classical physical signs may be absent. Percutaneous drainage under CT control provides an alternative to formal surgical drainage in selected patients.

Abscess↗
PubMed1987

Recurrent psoas abscess.

Recurrence of a psoas abscess in exactly the same location is very unusual--in fact, we found no other reports in the literature. Laparotomy performed after the patient presented with the second abscess revealed an impacted calculus and diverticulitis of the appendix as the cause. Computed tomography was effective in establishing the diagnosis, but the question of the best method of treatment remains. Percutaneous drainage was insufficient in this case.

Abdomen↗
PubMed2000

Psoas abscess complicating Crohn's disease: report of a case.

We describe herein the case of a psoas abscess complicating Crohn's disease, and present a review of the literature on this unusual disease entity. A 22-year-old Japanese man with a 5-year history of Crohn's ileocolitis presented with right lower abdominal and hip pain, and a diagnosis of right psoas abscess was subsequently made by abdominal computed tomography (CT). Following the administration of antibiotics and CT-guided percutaneous drainage of the abscess, the patient's symptoms temporarily improved; however, 2 weeks later, the abscess cavity was found to have extended around the periarticular tissue of the right hip joint. To prevent the development of septic arthritis of the hip joint, surgical drainage of the abscess cavity and ileocecal resection were immediately performed, after which the patient's condition greatly improved. The resected specimen showed Crohn's ileocolitis with an external fistula in the terminal ileum which was considered to have caused the psoas abscess. Since psoas abscess in Crohn's disease can result in serious complications such as septic arthritis of the hip joint if left untreated, aggressive treatment should be initiated without delay.

Adult↗
PubMed2003

Psoas abscess: the spine as a primary source of infection.

STUDY DESIGN: Case report, literature review, discussion. OBJECTIVES: To emphasize the role of the spine as primary source of infection for psoas abscess. SUMMARY OF BACKGROUND DATA: Spine-associated psoas abscesses increase with more frequent invasive procedures of the spine and recurring tuberculosis in industrialized countries. Diagnosis is often delayed by misinterpretation as arthritis, joint infection, or urologic or abdominal disorders. METHODS: We present six cases of psoas abscesses associated with spinal infections that were treated in our hospital from January to December 2001. Diagnostic and treatment concepts are discussed. RESULTS: Our data emphasize the importance of the spine as primary source of infection and suggest an increase in the incidence of secondary psoas abscess. Treatment includes open surgical drainage and antibiotic therapy. In patients with high operative risk and uniloculated abscess, a CT-guided percutaneous abscess drainage can be sufficient. It is essential to combine abscess drainage with causative treatment of the primary infectious focus. Related to the spine, this includes treatment of spondylodiscitis or implant infection after spinal surgery. Usually, several operations are necessary to eradicate bone and soft-tissue infection and restore spinal stability. Continuous antibiotic therapy over a period of 2-3 weeks after normalization of infectious parameters is recommended. CONCLUSION: The spine as primary source of infection for secondary psoas abscess should always be included in differential diagnosis. Because the prognosis of psoas abscess can be improved by early diagnosis and prompt onset of therapy, it needs to be considered in patients with infection and back or hip pain or history of spinal surgery.

Anti-Bacterial Agents↗
PubMed1998

Psoas abscesses complicating colonic disease: imaging and therapy.

Most surgeons think of psoas abscesses as a very rare condition related to tuberculosis of the spine, but in contemporary surgical practice they are more usually a complication of gastrointestinal disease. A case note study was undertaken on all patients treated for psoas abscess at two large hospitals in the mid-Trent region over a 2-year period. All seven patients presented with pyrexia, psoas spasm, a tender mass and leucocytosis. The diagnosis was made on abdominal radiographs in one patient, CT scan in three, MRI in two, and ultrasound in one. Aetiological factors included Crohn's disease in three, appendicitis in two, and sigmoid diverticulitis and metastatic colorectal carcinoma in one each. Six patients underwent transabdominal resection of the diseased bowel, retroperitoneal debridement and external drainage of the abscess cavity. Percutaneous drainage was performed in one. Two patients had more than one surgical exploration for complications. There were no deaths and the hospital stay ranged from 8-152 days. Psoas abscess can be a difficult and protracted problem. Bowel resection, thorough debridement, external drainage and concomitant antibiotics are essential for psoas abscesses complicating gastrointestinal disease. Defunctioning stomas may be necessary. However, in some cases a multidisciplinary approach may be required, as psoas abscesses can involve bone and joints.

Adult↗
PubMedDate not supplied

Tuberculous psoas abscess.

Although its historical significance is well established, Mycobacterium tuberculosis today is considered an extremely rare cause of psoas abscess. Nontuberculous bacterial infection, most commonly secondary to an intraabdominal process but at times appearing without an identifiable source, is responsible for the vast majority of psoas abscesses. The recent resurgence of tuberculosis may portend another change in the etiologic trend of psoas abscess. It is essential that the emergency physician not only recognize the potentially subtle presentation of psoas abscess, but also include tuberculosis in the differential diagnosis of infectious causes of this entity. A case of tuberculous psoas abscess in an HIV-negative man is presented. A review of the anatomy, pathophysiology, clinical presentation, epidemiology, and treatment follows, highlighting the similarities and differences between tuberculous and nontuberculous psoas infection.

Antitubercular Agents↗