The relationship between blunt abdominal trauma and intra-abdominal abscess (IAA) is discussed infrequently; therefore we conducted a retrospective review of 4050 multiple blunt trauma admissions from January 1986 to July 1988. Of 325 patients who had a laparotomy for blunt abdominal trauma, we identified 15 (4.6%) who had 40 IAAs. The most common intra-abdominal injuries involved the spleen and liver. Splenectomy increased the risk for IAA in contrast to splenic salvage. Blunt injuries to the kidney and pancreas, when occurring in multiple trauma patients, carried a significant risk of IAA. Associated multiple extra-abdominal injuries and high transfusion requirements increased the risk for IAA formation. Most of the IAAs were located in the upper quadrants. There was a 46% incidence of multiple IAA, which in turn had an 80% chance of recurrence after initial drainage. Enterobacter species played an important role in the formation of IAA in our trauma patients. Three patients (20%) died. Poor prognostic indicators included a high injury severity score, high transfusion requirements, the presence of pelvic fracture, positive blood cultures, multiple organisms per abscess, and multiple-organ system failure.
19675 Background: Psoas abscess is regarded as a rare disease in medical literature, more so as primary presentation of malignancy or its recurrence. We describe a series of 10 cancer patients who presented with psoas abscess seen in a 18 month period at a large tertiary care cancer hospital in northern India. They were subsequently diagnosed as having malignancy or recurrence of a past malignancy. Methods: A retrospective study of cancer patients who presented with psoas abscess was undertaken. We reviewed clinical data from patients who presented in the period from April 2005 to December 2006 at the Patel Cancer & Superspeciality hospital, Jalandhar, India. Results: In this period 10 cases of cancer met the diagnosis of psoas abscess at presentation. The average age was 51 years (range 20 to 85) with a male female ratio of 4:1. In 7 patients psoas abscess was the presentation at initial diagnosis while in 3 patients it was the presentation of recurrence/relapse. None of the patients had any predisposing conditions like IV drug use, diabetes mellitus, hematoma or HIV positivity.. Majority (7/10) of primary tumors were genito- urinary cancers (Renal - 2, Ureter - 1, Cervix - 1, Prostate - 1, Dysgerminoma - 1, Penis-1) while 3 were of unknown origin. Squamous cell carcinoma was the commonest histology (4/10), followed by metastatic adenocarcinoma (3/10). Majority of the abscess were left sided (7/10) corresponding to the side of primary lesion. Under lying destruction of iliac bone with metastasis was found in only 2 patients. Most of the patients (9/10) responded poorly to treatment ie chemotherapy and radiotherapy, all of them dying of disease progression within a year. Conclusions: Psoas abscess can be a rare presentation of intra abdominal malignancy. Pre disposing factors may not necessarily be present. Genito-urinary malignancies should be kept in the differential diagnosis of unexplained psoas abscesses. Development of psoas abscess does not always signify metastatic disease but portends a poor prognosis to treatment. No significant financial relationships to disclose.
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