Acute Pyogenic Iliopsoas Abscess in Taiwan: Clinical Features, Diagnosis, Treatments and Outcome

Huang, Jeng-Jong; Ruaan, Mirng-Kuhn; Lan, Rong-Ru; Wang, Mingcheng

doi:10.1053/jinf.2000.0643

Cited by 83 publications

(78 citation statements)

References 31 publications

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“…The mortality rate has been reported as high as 44% and as low as 3% in the literature [4,13]. In the present study, the overall mortality rate was 18%: 13% (1 of 8) and 22% (2 of 9) in patients with primary and secondary PAs (p = 0.60), respectively.…”

Section: Discussionsupporting

confidence: 49%

Pyogenic Psoas Abscess: Difficulty in Early Diagnosis

Hamano¹,

Kiyoshima²,

Nakatsu³

et al. 2003

Urol Int

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Aim: To report on the clinical features, diagnosis, and treatment of psoas abscess (PA) with special attention to the presence of septic shock. Patients and Methods: This study included 17 patients (mean age 66.2, range 43–81 years) with PA. Treatment consisted of intravenous administration of antibiotics and abscess drainage, either surgical or percutaneous with ultrasound guidance. Results: The typical patients presented with fever >38°C (16/17, 94%), pain in back, flank, or abdomen (15/17, 88%), hip flexion contracture with pain extension (14/17, 82%), and mass felt in the flank (5/17, 29%). All 8 patients without septic shock (100%) had the clinical triad (fever, pain in back, flank, or abdomen, and hip flexion contracture) as compared with 4 of 9 patients with septic shock (44%) (p = 0.012). The duration of symptoms before hospitalization was significantly shorter in the patients with septic shock (median 2, range 1–5 days) than in those without septic shock (median 18.5, range 11–63 days; (p = 0.0005). The mortality rates were 33% (3 of 9) and 0% (0 of 8) in the patients with and without septic shock, respectively (p = 0.071). Conclusions: PA patients with septic shock had a tendency to have nonspecific symptoms and an occult clinical course as compared with those without septic shock. A delay in diagnosis and treatment can result in a worse clinical outcome (death or totally disabled state). Increased awareness of this condition should lead to earlier diagnosis and treatment with improved outcomes.

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Section: Discussionsupporting

confidence: 49%

Pyogenic Psoas Abscess: Difficulty in Early Diagnosis

Hamano¹,

Kiyoshima²,

Nakatsu³

et al. 2003

Urol Int

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“…The mortality of this disease showed a wide variation among different reports, with the highest being 44% in one case series 29 , and several case series showed zero mortality 10,12,16 . The statistical significance was limited because of insufficient sample size in most of the reports.…”

Section: Discussionmentioning

confidence: 95%

An Update on Psoas Muscle Abscess: An 8-Year Experience and Review of Literature

Lai

Lin

Wang

et al. 2011

International Journal of Gerontology

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s u m m a r y Background: Psoas muscle abscess is a previously rare disease that has increased in its reported prevalence because of improved diagnostic tools. The literature on psoas muscle abscess mostly consists of case reports and case series. Methods: We analyzed medical records, such as characteristics, pathogens, and disease pattern, from our hospital in the past 8 years and report nine cases of psoas abscess. We also reviewed the literature for case series and performed a meta-analysis to assess the current characteristics of this disease since 1986. Results: We reviewed a total of 36 studies, with a total of 682 cases. The average age was 52.6 years, and the mortality rate was 8% (55 of 682). In 35 studies, a total of 274 cases (40.77%) received drainage (274 of 672), whereas 290 (43.15%) received surgery. In 522 cases, the ratio of primary to secondary etiologies was 1:1.71. In 209 cases, Staphylococcus aureus, and in 70 cases, Escherichia coli were identified as the pathogens from culture data. Compared with Ricci's case series, we found an obvious increase in prevalence of secondary causes (63.2% compared with 21.8%) and higher mortality in recent study (6.7% in Ricci's study and 8.1% in recent study). There was an obvious shift toward drainage as the treatment of choice. Conclusions: We conclude that a higher mortality has occurred in recent study, and psoas abscess is an infrequent and easily overlooked infectious disease requiring early diagnosis with favorable results with percutaneous drainage.

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“…In the past, in cases involving multilocular abscesses (22), a large abscess size (>70 mm) (6) or gas-forming abscesses (7), there was a danger of treatment failure with percutaneous drainage, leading to the need for surgery. Even in a recent series including a large number of patients, placing multiple drainage tubes was not found to be common (23).…”

Section: Discussionmentioning

confidence: 99%

Case Series of Iliopsoas Abscesses Treated at a University Hospital in Japan: Epidemiology, Clinical Manifestations, Diagnosis and Treatment

et al. 2015

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Objective The incidence of iliopsoas abscesses has been increasing due to advances in diagnostic imaging techniques and the increased number of elderly individuals and immunodeficient patients with co-morbidities. Our aim was to investigate the management and treatment of iliopsoas abscesses, particularly the effectiveness of computed tomography (CT)-guided drainage in the era of interventional radiology. Methods A retrospective analysis was performed at a university hospital between January 2009 and March 2014. Patients There were 15 patients (eight men, seven women) 50-85 years of age (average: 70 years) diagnosed with an iliopsoas abscess. Results The etiology of the disease was investigated in 14 of the 15 patients, each of whom had a secondary iliopsoas abscess. The primary condition in nine of these patients (64.3%) was an orthopedic infection (spondylodiscitis); the most common symptom was fever (12 patients, 80%). Altogether, 10 patients (66.7%) had a multilocular abscess and five (33.3%) had bilateral abscesses. The most common pathogen was Staphylococcus aureus (seven patients, 50%). All 14 patients underwent drainage: 11 received CT-guided drainage, two underwent postdrainage surgery and one received ultrasonography-guided drainage. Poor drainage was overcome by inserting multiple drainage tubes (six patients) or performing transmembrane drainage with a guidewire. All but one patient survived. Conclusion Based on the high success rate of CT-guided drainage in this study, this technique is expected to continue to play a major role in cases requiring drainage, even in patients with bilateral or multilocular abscesses. However, this modality cannot be used in cases of gastrointestinal perforation.

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Acute Pyogenic Iliopsoas Abscess in Taiwan: Clinical Features, Diagnosis, Treatments and Outcome

Cited by 83 publications

References 31 publications

Pyogenic Psoas Abscess: Difficulty in Early Diagnosis

Pyogenic Psoas Abscess: Difficulty in Early Diagnosis

An Update on Psoas Muscle Abscess: An 8-Year Experience and Review of Literature

Case Series of Iliopsoas Abscesses Treated at a University Hospital in Japan: Epidemiology, Clinical Manifestations, Diagnosis and Treatment

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