A Rare Case Of Sigmoid Colon Perforation With Subsequent Psoas Abscess Collection With Extensive Involvement Of The Sartorius Muscle

Abstract

A middle-aged man was admitted with worsening hip pain, fevers and reduced mobility. These symptoms were preceded by a mechanical fall but despite regular analgesia, symptoms did not resolve. His prior medical history included ischaemic heart disease, hypertension and hypercholesterolaemia. A trauma and orthopaedic review revealed a painful left hip with reduced range of motion. In addition, some mild tenderness in the left iliac fossa was noted. Blood tests revealed markedly raised inflammatory markers. Plain radiographs and ultrasound were normal. MRI scan found a massive left iliopsoas collection secondary to perforated diverticular disease of the sigmoid colon. The patient was managed with intravenous antibiotics and the collection was drained percutaneously. Approximately 500 mL of pus was aspirated. The patient made an excellent recovery with interval imaging showing a reduction in the collection size.

Complex Sigmoid Diverticulitis Presenting as Tubo-Ovarian Abscess and Developed Iliopsoas Abscess as Complications

“…The close proximity of the left fallopian tube and ovary to the sigmoid colon means that there is always a chance of diverticulitis infiltrating the left ovary/fallopian tube and causing a tubo-ovarian abscess. Such an infiltration is indistinguishable from other common causes [6].…”

“…Diverticulitis is a very common condition that usually presents with left iliac fossa pain, fever, and diarrhoea, classic symptoms that facilitate early diagnosis and effective management. On the other side, the same condition can present with atypical symptoms that are usually misdiagnosed and can result in intense complications, including iliopsoas abscess, as seen in the study case and in [6], or fistula, stricture and perforations [5], which have been life threatening.…”

Thigh Abscess as an Uncommon Complication of Left-Sided Colonic Diverticulitis and the Pitfalls in Treatment: An Interesting Case Report

“…We present a rare case of sigmoid diverticulitis without any abdominal paracolic collection, presenting with a fulminant abscess in the thigh and masquerading with musculoskeletal complaints rather than abdominal symptomatology. Only a few prior documented case reports in the published literature are available for review [4,5,6], and it highlights the need for swift abdominal intervention in such cases, irrespective of the abdominal collection.…”