Outcome of percutaneous continuous drainage of psoas abscess: A clinically guided technique

Abstract

Background:Percutaneous aspiration of abscesses under ultrasonography (USG) and computer tomography (CT) scan has been well described. With recurrence rate reported as high as 66%. The open drainage and percutaneous continuous drainage (PCD) has reduced the recurrence rate. The disadvantage of PCD under CT is radiation hazard and problems of asepsis. Hence a technique of clinically guided percutaneous continuous drainage of the psoas abscess without real-time imaging overcomes these problems. We describe clinically guided PCD of psoas abscess and its outcome.Materials and Methods:Twenty-nine patients with dorsolumbar spondylodiscitis without gross neural deficit with psoas abscess of size >5 cm were selected for PCD. It was done as a day care procedure under local anesthesia. Sequentially, aspiration followed by guide pin-guided trocar and catheter insertion was done without image guidance. Culture sensitivity was done and chemotherapy initiated and catheter kept till the drainage was <10 ml for 48 hours. Outcome assessment was done with relief of pain, successful abscess drainage and ODI (Oswestry Disability Index) score at 2 years.Results:PCD was successful in all cases. Back and radicular pain improved in all cases. Average procedure time was 24.30 minutes, drain output was 234.40 ml, and the drainage duration was 7.90 days. One patient required surgical stabilisation due to progression of the spondylodiscitis resulting in instability inspite of successful drainage of abscess. Problems with the procedure were noticed in six patients. Multiple attempts (n = 2), persistent discharge (n = 1) for 2 weeks, blocked catheter (n = 2) and catheter pull out (n = 1) occurred with no effect on the outcome. The average ODI score improved from 62.47 to 5.51 at 2 years.Conclusions:Clinically guided PCD is an efficient, safe and easy procedure in drainage of psoas abscess.

A Pain in the Psoas

“…In one study, percutaneous drainage was successful in 90% of cases. 4,11,16,18,27 In this case, percutaneous drainage was not feasible, as no focal collection was identified early in the case. After repeat CT revealed possible pyomyositis, the patient was taken to the operating room for surgical exploration of the psoas muscle in the retroperitoneal compartment; however, no infection was identified at this time as the infection was localized more distally, near the psoas insertion on the lesser trochanter.…”

Comparison of the Anteroposterior and Posterior Approaches for Percutaneous Catheter Drainage of Tuberculous Psoas Abscess

“…Previous reports on the use of PCD using a posteroanterior (PA) approach have combined this with conservative anti-TB therapy [ 9 – 11 ]. However, when lumbar vertebral TB requires surgery, if there is unilateral or bilateral psoas abscess, the anterior approach alone can eradicate the infection focus, but anterior instrumentation may be more challenging at the level of lower lumbar vertebral disease (L4–5, L5–S1) and for multi-level lesions [ 20 ].…”

“…During the past ten years, PCD has been used in the treatment of abscess due to TB [ 9 – 11 ], but there are few reports on the treatment of lumbar tuberculosis with psoas abscess by posterior PCD (P-PCD). Furthermore, there have been no clinical studies to compare the clinical outcome following anteroposterior PCD (AP-PCD) and P-PCD.…”

Late onset ilio-psoas abscess due to stump appendicitis: a case report

“…Ultrasonography guided percutaneous drainage is the method of choice for drainage of localized intraabdominal collections as it is efficient, less invasive with low radiation hazards [ 9 ] , nevertheless, surgical drainage provides a method to treat an underlying pathology. In our case we started management by percutaneous drainage of the abscess; however, when the patient still complained of the same symptoms, despite good drainage, we suspected the presence of unusual cause to be the primary source of infection.…”