Unusual presentation of psoas abscess in a child

Kleiner, Oleg; Cohen, Zvi; Barki, Y; Mares, Abraham J.

doi:10.1053/jpsu.2001.28870

Cited by 9 publications

(5 citation statements)

References 11 publications

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“…In general, iliopsoas abscess has a subacute clinical course, and patients seek medical assistance in an average of 5–6 days after the onset of signs and symptoms. Children may present with a more acute presentation ( 3 , 57 ). Pyomyositis, including iliopsoas abscess(es), has three consecutive clinical stages ( 58 , 59 ).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Percutaneous Drainage of Iliopsoas Abscess With Septicemia in an Adolescent: A Case Report and Literature Review

Jiang¹,

Zhang

Fu³

et al. 2022

Front. Surg.

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IntroductionIliopsoas abscess with septicemia in the pediatric population is rare. Early diagnosis and effective management of this emergent disorder remain challenging for clinicians.Case PresentationA 14-year-old girl presented with right lateral and posterior hip pain and fever for 7 days before admission. Blood culture was positive for Staphylococcus aureus. Enhanced magnetic resonance imaging revealed abscesses located in the right iliopsoas muscle and on the surface deep to the fascia of the right sacroiliac joint that were 6.8 cm × 6.2 cm × 5.7 cm and 3.7 cm × 3.5 cm × 2.1 cm, respectively. A diagnosis of right iliopsoas abscesses with septicemia was made. The patient received intravenous antibiotics, underwent ultrasound-guided percutaneous catheter drainage, and recovered uneventfully. Medical literature regarding this issue published in the English language during the last two decades was reviewed.DiscussionPrimary synchronous psoas and iliacus muscle abscesses are rare and emergent disorders in the pediatric age group. The diagnosis is generally delayed owing to the deep anatomic location and nonspecific signs and symptoms. A comprehensive medical history, meticulous physical examination, and judicious use of imaging studies could establish a timely and accurate diagnosis. Surgeons should be aware of the occurrence of multiple abscesses. Prompt and adequate antibiotic therapy accompanied by a mini-invasive approach, such as ultrasound-guided, laparoscopic, or video-retroperitoneoscopic drainage of the infectious focus, if indicated and feasible, is important to achieve a good outcome in the management of iliopsoas abscess.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Percutaneous Drainage of Iliopsoas Abscess With Septicemia in an Adolescent: A Case Report and Literature Review

Jiang¹,

Zhang

Fu³

et al. 2022

Front. Surg.

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“…Abdominal ultrasound is believed to be a helpful tool, however that kind of diagnostics should be used cautiously due to the rarity of the condition in children. These lesions may occur even in neonates [1,5,9,10]. Management includes percutaneous drainage and general antibiotic therapy [1,5,9,10,17], however in cases of multi-loculated abscesses surgery may be required to drain the pus entirely [5]; this turned out to be also necessary in our patient.…”

Section: Discussionmentioning

confidence: 86%

“…These lesions may occur even in neonates [1,5,9,10]. Management includes percutaneous drainage and general antibiotic therapy [1,5,9,10,17], however in cases of multi-loculated abscesses surgery may be required to drain the pus entirely [5]; this turned out to be also necessary in our patient. Conservative treatment including ultrasound and CT-guided percutaneous needle aspiration/drainage associated with systemic antibiotics has become the preferred method of treatment [17].…”

Section: Discussionmentioning

confidence: 86%

Tumour-Like Inflammatory Abdominal Conditions in Children

Latawiec-Mazurkiewicz

Juszkiewicz²,

Pacanowski³

et al. 2005

Eur J Pediatr Surg

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The presence of a tumour, poor general condition, features of anaemia, increased erythrocyte sedimentation rates and imaging suggesting malignancy were the common features in 4 different tumour-like abdominal conditions that are extremely rare in childhood. These conditions included: extensive retroperitoneal tumour with rib involvement that turned out to be an inflammatory lesion caused by Actinomyces in a 12-year-old girl; multi-loculated tumour of the mesentery/ovary caused by mesenteric lymphadenopathy in the course of a Salmonella enteritidis infection in a 2.5-year-old girl; tumour of the VII - VIII hepatic segments that turned out to be the focus of granuloma in the course of lambliasis in a 5.5-year-old boy with a history of purulent neck lymphadenopathy and a final suspicion of immunocompromise; and a multi-loculated tumour of the small pelvis and inguinal area that turned out to be an abscess of the iliopsoas muscle in a 16-year-old boy. Apart from the imaging, the lesions required cytological examination of the material harvested by fine-needle biopsies (liver tumour) or histopathological investigations (retroperitoneal tumour, mesenteric/ovarian tumour, liver tumour and--on second surgery--the pelvic tumour) and/or bacteriological examination (all cases), serological examination (liver tumour and mesenteric/ovarian tumour), protozoal investigation (liver tumour), and measurement of AFP levels (mesenteric/ovarian tumour). Surgical treatment (retroperitoneal tumour, mesenteric/ovarian tumour and tumour of the small pelvis) and guided antibiotic therapy (all cases including 15 weeks of antibiotics in the first case) allowed complete recovery in 3 patients (actinomycosis, mesenteric lymphadenopathy, abscess of the iliopsoas muscle). Antibiotic and antiprotozoal therapy cured the granulomatous hepatitis; however this patient tended to develop severe right-sided pleural/pulmonary changes (the child was referred for further diagnosis with suspicion of immunocompromise).

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“…On primary psoas abscess, the fascias usually prevent spreading of abscess to retroperitoneal and free peritoneal space. Bacterial peritonitis with psoas abscess was observed in three cases [10][11][12]. These cases were caused by ruptured psoas abscess and at least two cases were primary psoas abscess.…”

Section: Discussionmentioning

confidence: 99%

Psoas abscess and bacterial peritonitis caused by urinary tract infection in a patient of liver cirrhosis and diabetes mellitus

Kamikado

Taguchi

Wakiyama

et al. 2009

Clin J Gastroenterol

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Prognosis of patients with diabetes mellitus or liver cirrhosis can be worsened by the development of a variety of infectious diseases. We describe a case of psoas abscess and bacterial peritonitis in a 58-year-old woman with type C liver cirrhosis and diabetes mellitus hospitalized after having an elevated temperature caused by urinary tract infection for 2 months. The cirrhosis had not been treated and daily self-administration of insulin had been discontinued for the previous 5 months. On day 2 of hospitalization, vomiting and decreased blood pressure developed. Abdominal computed tomography scan revealed ascites, pneumoperitoneum, and psoas abscess. Laparotomy revealed psoas abscess and bacterial peritonitis without gastrointestinal perforation and psoas abscess perforation. Surgical drainage of the abscess and peritoneal cavity was performed. Immediately after the operation, upper gastrointestinal bleeding, shock, hypoglycemia, and metabolic acidosis developed, followed by hepatic failure, renal insufficiency, and cerebral dysfunction. Death occurred on postoperative day 19. Upon autopsy, bacterial peritonitis residue of psoas abscess, and urinary tract infection were confirmed. We surmise that untreated liver cirrhosis and diabetes mellitus is a risk for urinary tract infection that may spread in iliopsoas and free peritoneal space.

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Unusual presentation of psoas abscess in a child

Cited by 9 publications

References 11 publications

Ultrasound-Guided Percutaneous Drainage of Iliopsoas Abscess With Septicemia in an Adolescent: A Case Report and Literature Review

Ultrasound-Guided Percutaneous Drainage of Iliopsoas Abscess With Septicemia in an Adolescent: A Case Report and Literature Review

Tumour-Like Inflammatory Abdominal Conditions in Children

Psoas abscess and bacterial peritonitis caused by urinary tract infection in a patient of liver cirrhosis and diabetes mellitus

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