Psoas abscess rarely requires surgical intervention

Yacoub, Wael; Sohn, Helen J.; Chan, Sirius; Petrosyan, Mikael; Vermaire, Hope M.; Kelso, Rebecca; Towfigh, Shirin; Mason, Rodney J.

doi:10.1016/j.amjsurg.2007.07.032

Cited by 111 publications

(99 citation statements)

References 19 publications

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“…One-third of our patients presented with multilocular abscesses, which is an important criterion when selecting the treatment strategy. As reported in previous studies, the causative pathogen in most cases was S. aureus (2,9,(12)(13)(14). Although this trend is well recognized, several other bacteria have also been isolated.…”

Section: Discussionmentioning

confidence: 80%

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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Section: Discussionmentioning

confidence: 80%

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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“…The first IPA radiologic (US, CT) guided percutaneous drainage occurred in 1984 9 , and since then, the best therapeutic option has been on debate. So far, the treatment choice is the guided percutaneous drainage, as it is the least invasive and associated with lower morbidity and mortality 10 ; however, many local and systemic factors of each patient may influence the therapeutic choice 11 .…”

Section: Bilateral Paracoccidioidomycotic Iliopsoas Abscess Associatementioning

confidence: 99%

Bilateral paracoccidioidomycotic iliopsoas abscess associated with ileo-colonic lesion

Duani

Nunes

Assumpção

et al. 2012

Rev. Soc. Bras. Med. Trop.

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FIGURE 1 -Colonoscopy revealing the cecum and the ileocecal valve, a large ulcer, and an ulcer with fibrin (arrows). Revista da Sociedade Brasileira de Medicina Tropical 45(5):649-651, Sep-Oct, 2012Case Report ABSTRACT This case report shows the clinical development of a patient with systemic paracoccidioidomycosis presenting with lymphatic-intestinal manifestation. The patient initially had a substantial clinical improvement but had a recrudescence after six months of sulfamethoxazoletrimethoprim oral treatment, with the emergence of feverish syndrome, lumbar pain, and intermittent claudication, characterizing a bilateral iliopsoas muscle abscess, necessitating clinicosurgical therapeutics.Keywords: Paracoccidioidomycosis. Psoas abscess. Paracoccidioides brasiliensis.fungal smear; normal renal and hepatic function panels; and negative microbiological stool tests. An abdominal and pelvic computed tomography (CT) demonstrated mesenteric lymphadenomegaly, with a hypodense center. Colonoscopy evidenced multiple deep ulcers with changeable sizes and forms along the whole colon, intercalated by normal mucosa, and a deformed ileocecal valve, which favored the diagnosis of infectious ulcerative pancolitis (Figure 1). Anatomopathological examination of the colonic mucosa revealed some areas of erosion covered in fibrino-leukocytic exudate, inflammatory infiltrate in corion, with some multinucleated giant cells, and lots of round shaped yeast, in various sizes, compatible with ileum-colonic PCM (Figure 2). A biopsy of a cervical lymph node also was performed, and in the anatomopathological examination, we found the Paracoccidioides brasiliensis, with non-caseating granulomas containing multinucleated giant cells and epithelioid histiocytes, presenting a steering wheel shape, compatible with PCM granulomatous lymphadenitis. During hospitalization, the patient was treated with venous sulfamethoxazole-trimethoprim (SMX-TMP) and amphotericin B (amphoB) deoxycholate, receiving a cumulative dose of 1,900mg after www.scielo.br/rsbmt 650 Duani H et al -Bilateral paracoccidioidomycotic iliopsoas abscess DISCUSSION 38 days. A complete regression of lymphadenopathy occurred, the patient gained weight, and the diarrhea ceased. After 40 days from admission, he was discharged, with a prescription of a daily use of SMX-TMP 800 + 160mg.The patient returned 40 days later, presenting recrudescence of the initial symptoms, including pain in the left hip, limited extension of the homolateral hip, limping, and fever. Furthermore, cultures were obtained, and an anatomopathological examination of an inguinal lymph node biopsied revealed Paracoccidioides brasiliensis. He was rehospitalized and treated with amphoB plus oral itraconazole and sulphadiazine.Abdominal and pelvic CT showed mesenteric lymphadenomegaly, enlargement of the left iliac and psoas muscles, with inner voluminous liquefaction, which extended from the level of the third lumbar vertebra (L3) to the pelvis. Moreover, a smaller collection was observed in the right psoas muscle at...

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“…Yacoub et al suggested that psoas abscesses measuring <3 cm in maximum diameter may be managed successfully with antibiotics alone, whereas those >3 cm in size may require surgical intervention (open or CT-guided drainage) (26). In the present case, antibiotic treatment alone was considered to be insufficient because the patient had an iliopsoas abscess with a maximum diameter of >3 cm complicated with osteomyelitis of the femoral head; therefore, surgical drainage was performed.…”

Section: Discussionmentioning

confidence: 90%

Bacteremia with an Iliopsoas Abscess and Osteomyelitis of the Femoral Head Caused by <i>Enterococcus avium</i> in a Patient with End-stage Kidney Disease

2015

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A 70-year-old man on hemodialysis for end-stage kidney disease due to polycystic kidney disease presented with hip pain on extension and a high C-reactive protein level. Further examinations revealed an iliopsoas abscess and femoral head osteomyelitis caused by Enterococcus avium (E. avium) detected in blood and pus cultures. Complete resolution of the infection with ampicillin-resistant E. avium required six months of vancomycin therapy and two surgical drainage procedures. There have been no previous case reports in which both blood and abscess cultures confirmed E. avium infection. Careful attention should be paid to the detection of non-specific symptoms in patients on hemodialysis, with blood cultures being essential in such cases.

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Psoas abscess rarely requires surgical intervention

Cited by 111 publications

References 19 publications

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

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

Bilateral paracoccidioidomycotic iliopsoas abscess associated with ileo-colonic lesion

Bacteremia with an Iliopsoas Abscess and Osteomyelitis of the Femoral Head Caused by <i>Enterococcus avium</i> in a Patient with End-stage Kidney Disease

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