A case report on delayed diagnosis of perforated Crohn’s disease with recurrent intra-psoas abscess requiring omental patch

Gao, David X.; Medina, Marcelo Gabriel; Alameer, Ehab; Nitz, Jonathan; Tsoraides, Steven S.

doi:10.1016/j.ijscr.2019.11.021

Cited by 4 publications

(4 citation statements)

References 16 publications

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“…Intestinal penetrations, fistulae, or abscesses can be the first manifestations of CD because of its often insidious progression [ 1 , 12 ]. Among abscesses caused by CD, IMAs are relatively rare (occurring in 0.4% to 4.3% of patients) with nonspecific manifestations [ 14 ], making it difficult to diagnose CD as the underlying cause of IMAs [ 15 , 16 ]. However, identification of the causative bacteria of an IMA can help identify the mechanism of development as either primary or secondary.…”

Section: Discussionmentioning

confidence: 99%

Polybacterial Iliopsoas Muscle Abscess as an Indication for Early Diagnosis of Crohn\'s Disease

Yamashita,

Nakamura,

Akutagawa

et al. 2023

Am J Case Rep

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Patient: Male, 22-year-old Final Diagnosis: Crohn’s disease Symptoms: Hip pain Clinical Procedure: — Specialty: Critical Care Medicine • Gastroenterology and Hepatology Objective: Unusual clinical course Background: Crohn disease (CD) is a chronic, relapsing inflammatory bowel disease characterized by penetrations or fistulae in the gastrointestinal tract and abscesses in the surrounding tissues. Diagnosis of CD is difficult with an iliopsoas muscle abscess (IMA) as an initial presentation. Case Report: A 22-year-old Japanese man had right hip pain 17 days prior to admission. Because of worsening pain, he was admitted to our hospital. Physical examination revealed limitation of his right hip motion and a positive right psoas sign. Abdominal contrast-enhanced computed tomography (CT) revealed a large right IMA. Continuous drainage, which revealed polymicrobial pus, with intravenous administration of antibiotics dramatically decreased the size of the IMA. The drainage tube was removed on hospitalization day 9 because barium enema and contrast radiography of the abscess through the drainage tube showed no fistula. However, on day 19 of hospitalization, the IMA was redetected by abdominal CT. Continuous abscess drainage was resumed, and the third contrast radiograph of the abscess revealed contrast medium flow into the small intestine. Colonoscopy detected stenoses and circumferential ulceration of the terminal ileum. Histopathological examination of the ileum biopsy showed histocyte aggregation with lymphocyte or plasmacyte infiltration of the lamina propria, compatible with a CD diagnosis. Laparoscopic ileocecal resection was performed on day 64 of hospitalization. Conclusions: Penetration of the intestinal tract caused by CD should be suspected in a patient with a polymicrobial IMA. It is essential to identify the fistula and subsequently perform surgical resection of the affected intestinal area.

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Section: Discussionmentioning

confidence: 99%

Polybacterial Iliopsoas Muscle Abscess as an Indication for Early Diagnosis of Crohn\'s Disease

Yamashita,

Nakamura,

Akutagawa

et al. 2023

Am J Case Rep

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“…symptom relief (e.g., large collection causing pain, biliary tree, ureter, or bowel obstruction) [ 43 , 44 , 45 ]…”

Section: Figurementioning

confidence: 99%

Image-Guided Percutaneous Drainage of Abdominal Abscesses in Pediatric Patients

Kuhelj,

Langel

2024

Children

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Image-guided percutaneous abscess drainage (IPAD) is an effective, minimally invasive technique to manage infected abdominal fluid collections in children. It is the treatment of choice in cases where surgery is not immediately required due to another coexisting indication. The skills and equipment needed for this procedure are widely available. IPAD is typically guided by ultrasound, fluoroscopy, computed tomography, or a combination thereof. Abscesses in hard-to-reach locations can be drained by intercostal, transhepatic, transgluteal, transrectal, or transvaginal approaches. Pediatric IPAD has a success rate of over 80% and a low complication rate.

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“…Image-guided percutaneous catheter drainage (PCD) performed by interventional radiologists is commonplace for the evacuation of most abdominal fluid collections [1][2][3][4][5][6][7][8][9][10]. This is especially true for spontaneous and postoperative abscess evacuation.…”

Section: Introductionmentioning

confidence: 99%

Pilot Study on the Influence of Incentive Spirometry on Percutaneous Image-Guided Intra-Abdominal Drainage Catheter Pressure: A Potential Method to Enhance Drainage

et al. 2023

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Background: To report the evaluation of incentive spirometry (IS)-induced pressure changes in intra-abdominal drainage catheters and consider its use for maintaining catheter patency and enhancing drainage. Methods: Prospective study of patients with indwelling intra-abdominal drainage catheters for abdominal fluid collections who had their intra-abdominal pressures measured while performing incentive spirometry. Patients were instructed in the use of an incentive spirometer. Within a week after initial drainage, pressure changes with IS were evaluated three times at 1500 cc and three times at maximum inspiratory effort. Intra-abdominal pressure (IAP) was measured using a pressure monitor connected to the drainage catheter. Results: Twenty patients (men, 12; women, 8). Fluid collection locations were pelvis, Right-upper quadrant (RUQ), Left-upper quadrant (LUQ), Left-lower quadrant (LLQ), and Right-lower quadrant (RLQ). A total of 16 of 20 patients showed an elevation of IAP with IS. At 1500 cc, the pressure increased by an average of 41.24 mmH2O. At maximal inspiratory effort, the pressure increased by an average of 48.26 mmH2O. Pressure increase was greater in upper abdomen catheters. Four patients with lower abdominal and pelvic collections showed minimal pressure changes with IS. Conclusion: IS increases IAP and fluid flow through abdominal drainage catheters. Future studies are warranted to determine whether the use of IS enhances catheter performance and facilitates drainage via its effect on IAP.

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A case report on delayed diagnosis of perforated Crohn’s disease with recurrent intra-psoas abscess requiring omental patch

Cited by 4 publications

References 16 publications

Polybacterial Iliopsoas Muscle Abscess as an Indication for Early Diagnosis of Crohn\'s Disease

Polybacterial Iliopsoas Muscle Abscess as an Indication for Early Diagnosis of Crohn\'s Disease

Image-Guided Percutaneous Drainage of Abdominal Abscesses in Pediatric Patients

Pilot Study on the Influence of Incentive Spirometry on Percutaneous Image-Guided Intra-Abdominal Drainage Catheter Pressure: A Potential Method to Enhance Drainage

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