Retroperitoneal abscess complicating a normal delivery

Shah, Parag; Rane, V. A.; Moolgaoker, A. S.

doi:10.1111/j.1471-0528.1992.tb14479.x

Cited by 11 publications

(9 citation statements)

References 2 publications

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“…In addition, tumors arising from the structures within the pelvis or lumbar area may mimic a psoas abscess. [161723] In the postpartum period, special attention should be given to sepsis arising from endometritis, retained products of conception, or urinary tract infections. [29] In neurosurgical practice, psoas abscess must be considered in the differential diagnosis of low back and leg pain even without the presence of fever.…”

Section: Discussionmentioning

confidence: 99%

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Primary tuberculous psoas abscess as a postpartum complication: Case report and literature review

et al. 2018

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Background:Primary psoas abscess is an unusual clinical entity rarely encountered in the postpartum period. Only seven cases have been reported to date. Here, we present a woman with a primary psoas abscess caused by Mycobacterium tuberculosis and occurred 2 months following a normal vaginal birth. We highlight the difficulties in the management of this uncommon condition in light of the relevant literature.Case Description:A 34-year-old woman who was previously healthy was presented at 2 months’ postpartum with important right sciatica and low back pain without fever. Examination of the abdomen revealed tenderness in the right iliac fossa but obstetric/gynecologic and neurologic examinations were normal. The patient had an elevated C-reactive protein level and computed tomography (CT)-scan demonstrated a large psoas abscess on the right side without sacroiliac or spine abnormalities. Initial posterior lumbar percutaneous drainage was useful, but no pathogens were identified. The patient was discharged home with oral antibiotics therapy (amoxicillin/clavulanate and metronidazole). Four weeks later, the follow-up CT-scan showed a re-accumulation of the abscess cavity. Subsequently, the patient underwent a right anterolateral laparotomy with a retroperitoneal approach for abscess drainage. Again, no microorganisms were found. However, diagnosis of tuberculosis was established on histopathologic study. She was successfully treated with antituberculous drugs with a good outcome.Conclusions:Most primary psoas abscesses present with a delay in diagnosis because of the rarity of this infectious disease, the lack of specific symptoms and signs, and its similarity to many differential diagnoses. When suspected, CT-scan and/or magnetic resonance imaging help in making an accurate diagnosis and facilitate percutaneous or open surgical drainage of the abscess. Correct and fast identification of the microorganisms in addition to appropriate usage of antibiotic regimen improves the outcome.

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Section: Discussionmentioning

confidence: 99%

“…It has been suggested that trauma during delivery may cause an asymptomatic hematoma within the psoas muscle which can become infected. [81023] Another possibility is the disruption of the sacroiliac joint during delivery that may result in a retroperitoneal abscess. [23] Shahabi et al .…”

Section: Discussionmentioning

confidence: 99%

Primary tuberculous psoas abscess as a postpartum complication: Case report and literature review

et al. 2018

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“…A combination of antibiotics and simple aspiration may be adequate for a collection of moderate size [7,9]. If the collection is large but still contained in the retroperitoneal space, percutaneous drainage may be established with CT or ultrasound guidance to prevent recurrence [15][16][17][18][19]. Laparoscopy was used to guide the placement of continuous drainage in a pediatric case [20].…”

Section: Discussionmentioning

confidence: 99%

Puerperal Retroperitoneal Abscess Caused byClostridium difficile: Case Report and Review of the Literature

Wataganara

Sutantawibul²,

Anuwutnavin³

et al. 2014

Surgical Infections

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“…It has been postulated that trauma during delivery may cause a haematoma in the iliopsoas muscle which subsequently may become infected. 4,8,9 In our case, this would account for the pain preceding the pyrexia and the low haemoglobin on initial presentation.…”

Section: Discussionmentioning

confidence: 99%

Iliopsoas abscess: an unusual cause of postpartum sepsis

2009

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Summary: Iliopsoas abscess is uncommon in the postpartum period. This case illustrates the presentation of this unusual cause of postpartum sepsis and highlights difficulties in diagnosis.Keywords: maternal mortality, ultrasound CASE HISTORYA 31-year-old caucasian lady, para 4 þ 2, presented with left iliac fossa pain and rigors at four weeks postpartum following an unremarkable pregnancy. She delivered spontaneously at home with no midwife present. The placenta was delivered two hours after by a community midwife with no significant blood loss.Her presenting complaint was constant, severe left-sided lower abdominal pain radiating to the anterior aspect of the upper part of the thigh, becoming progressively more severe over the previous four weeks. This was associated with fever, rigors and vomiting for the past seven days. She described mild dysuria, but no bleeding or discharge per vaginum, and no respiratory or bowel symptoms. She was not breast feeding and had no mastalgia. There was no past history of diabetes, HIV, renal problems, trauma or gait problems. The patient was noted to have an allergy to penicillin.On admission, temperature was 38.68C, pulse rate 117 bpm and blood pressure 117/74 mmHg. On examination, the abdomen was soft with extreme tenderness over the left iliac fossa and groin. There was no guarding, rebound or renal angle tenderness. There were no clinical features of deep venous thrombosis. The chest and heart sounds were normal. Speculum examination visualized a normal cervix with no bleeding or discharge. Bimanual vaginal examination revealed an anteverted uterus and left adnexal tenderness but no masses. Examination of both hips and neurological examination of the lower limbs was unremarkable.Her blood tests were consistent with a diagnosis of sepsis with a raised white cell count, C reactive protein and elevated platelet count. A normocytic anaemia was also noted with haemoglobin of 6.9 g/dL. Midstream urine was positive for nitrites on dipstick testing, whereas a urinary pregnancy test was negative. Multiple cultures of blood and urine taken before antibiotics were commenced showed no growth after 72 hours. High vaginal and endocervical swabs were also negative. The patient was rehydrated and commenced empirically on intravenous ceftriaxone and metronidazole. In view of symptoms of dizziness, the patient was transfused three units of blood. Transvaginal pelvic ultrasound was unremarkable showing no evidence of a collection of retained products.Despite antibiotics, the pain and spikes in temperature persisted. Although inflammatory markers remained raised, the patient remained clinically stable and a further transvaginal ultrasound could not locate the cause of sepsis. On the third day after admission, as symptoms had not resolved, a computed tomography (CT) of the abdomen and pelvis was performed. This revealed a left iliopsoas abscess extending down into the left groin (Figure 1). The pus-filled abscess cavity was drained percutaneously under ultrasound guidance without complication....

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Retroperitoneal abscess complicating a normal delivery

Cited by 11 publications

References 2 publications

Primary tuberculous psoas abscess as a postpartum complication: Case report and literature review

Primary tuberculous psoas abscess as a postpartum complication: Case report and literature review

Puerperal Retroperitoneal Abscess Caused byClostridium difficile: Case Report and Review of the Literature

Iliopsoas abscess: an unusual cause of postpartum sepsis

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