Retroperitoneoscopic drainage of bilateral psoas abscesses under intraoperative laparoscopic ultrasound guidance

Abstract

Despite improved diagnostic modalities for psoas abscesses, the optimum management strategy is not uniform. A 67-year-old man presented with bilateral psoas abscesses secondary to L1-L2 pyogenic discitis. On contrast-enhanced CT, the largest of these abscesses measured 13 × 14 × 33 mm on the right. The patient developed sepsis caused by Klebsiella pneumonia. There were no signs of improvement after 3 weeks of systematic antibiotic administration. We performed surgical drainage of bilateral psoas abscesses by retroperitoneoscopy. Intraoperative laparoscopic ultrasound was useful to determine abscess location in the muscles prior to drainage and confirm no residual abscesses after drainage. The patient was afebrile 3 days later, and his clinical symptoms resolved. Retroperitoneoscopic drainage may represent a feasible minimally invasive therapeutic option for psoas abscess, and intraoperative laparoscopic ultrasound has the potential to increase the safety and efficacy of this surgical procedure.

Minimally invasive surgery for paravertebral or psoas abscess with spinal tuberculosis — a long-term retrospective study of 106 cases

“…The treatment regimens for thoracic and lumbar TB reported in the English literature include anti-TB chemotherapy (usually combined treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol) [2], traditional surgical treatment (anterior radical debridement with graft fusion or posterior debridement with fusion and fixation) [21][22][23][24][25], and minimally invasive approaches [19,[26][27][28][29][30][31][32].…”

“…As to vertebral instability and progressive deformity, percutaneous pedicle screw fixation should be performed to prevent vertebral collapse and kyphotic deformity. In the presence of extensive PA, PCD [34][35][36][37][38][39][40][41] or retroperitoneoscopic drainage [19,27,28] are the recommended treatments.…”

The effectiveness of a percutaneous endoscopic approach in a patient with psoas and epidural abscess accompanied by pyogenic spondylitis: a case report

“…When a psoas abscess is small, antibiotic therapy alone can be selected; however, when the abscess becomes large, drainage is recommended. Percutaneous drainage under CT or echo guidance is generally used for the drainage of psoas abscesses; however, drainage fails in a considerable number of cases, especially in cases involving multiloculated abscess cavities or with thick tenacious pus [5]. In such cases, an extraperitoneal approach has traditionally been performed.…”

Laparoscopic management for a psoas abscess caused by migrated urolithiasis

“…A case of a primary psoas abscess was attributed to the spread of Staphylococcus aureus . In secondary psoas abscesses, the spread of infection from vertebrae or vertebral discs was the most common cause . The spread of infection from gastrointestinal diseases was identified as the secondary cause .…”

“…3 In secondary psoas abscesses, the spread of infection from vertebrae or vertebral discs was the most common cause. [4][5][6] The spread of infection from gastrointestinal diseases was identified as the secondary cause. 7-10 Laparoscopic management was performed by transperitoneal and extraperitoneal approaches in four and 42 cases, respectively.…”