Percutaneous drainage of iliopsoas abscess: an effective option in cases not suitable for surgery

Abstract

The aim of this study were to describe the technique of percutaneous drainage of iliopsoas abscess, and to discuss the benefits of using this minimally-invasive tool. A single center study with retrospective analysis of patients with psoas abscess confirmed by imaging scans, sent to the interventional medicine center and submitted to computed tomography and ultrasound-guided percutaneous drainage, from November 2013 to August 2016. Seven patients underwent percutaneous drainage of psoas abscess in this period. The mean initial drained volume was 61.4±50.7mL (ranging from 10 to 130mL), and the mean drainage duration was 8.3±2.8 days (ranging from 4 to 12 days). The success rate of the percutaneous procedures was 71.5%, and two patients required re-intervention. Image-guided percutaneous drainage of iliopsoas abscess is a minimally invasive, efficient and safe procedure, and an extremely valuable technique, especially for patients who are not suitable for surgical repair.

Characteristics and Outcomes of Psoas Abscess: Experience From a Tertiary Care Center in North India

“…Around half of our cases underwent USG-guided drainage through a pigtail catheter and one-fourth required open surgical drainage. Our experience supports the findings of Martins et al [15], suggesting that percutaneous drainage is a minimally invasive, efficient, and safe procedure, with a good recovery and lower cost. Literature suggests that open drainage is usually required when concomitant abdominal pathology requires an open surgical procedure [16].…”

A case report of minimally invasive percutaneous ultrasound guided tuberculous iliopsoas abscess drainage in an immunocompromised patient

“…In a study from India on tuberculous psoas abscess delineated with pre procedure CT which were drained via ultrasound guided percutaneous drainage with placement of a drainage catheter successful drainage was achieved, on average within 10 days, in 84.6% of cases with no significant complications noted [15] . Needle aspiration alone without placement of a catheter was seen to be ineffective and showed high levels of recurrence [13] . As with our case ultrasound guided catheter placement and drainage was left for 10 days at which on the tenth day minimal fluid was draining over a 24-hour period with repeat CT scan showing successful drainage of abscess and follow up 3 months later revealing no residual collection.…”

“…The evolution of minimally invasive procedures with interventional radiology, the first line treatment of psoas abscess has now shifted from open surgical drainage towards percutaneous drainage via ultrasound or CT guidance. Advancements in imaging techniques and personnel expertise has helped favour this approach as it leads to lower morbidity and mortality with a shorter hospital stay, quicker wound recovery and less complications as compared to the conventional open surgical approach by avoiding general anesthesia and surgical stress [13] . Concerns however have been raised on its role in patients presenting with severe sepsis, thick pus collections and for those abscesses due to underlying conditions requiring surgical intervention such as diverticulitis.…”

A gigantic iliopsoas abscess in a patient with Alexander's disease

“…Percutaneous drainage of the iliopsoas abscess is a minimally invasive, efficient, and safe procedure with good clinical recovery. 1,2,3 In many cases, surgery with a high risk of morbidity and mortality can be avoided. This procedure is a significant option for patients who are unable to undergo surgery due to poor clinical status or other contraindications.…”