Iliopsoas abscess: clinical presentation, management, and outcome

Abstract

Background: The aim of this study was to review our experience with iliopsoas abscesses (IPAs) and evaluate the various drainage procedures.Methods: All consecutive patients with an IPA admitted to three university hospitals between September 2008 and June 2017 were retrospectively included.Results: Of the 26 patients, 17 (65.4%) were male and nine (34.6%) were female, with an average age of 30.7 (17-58) years. Fifteen (57.7%) cases had primary IPAs and Staphylococcus spp. was the most common isolate. Eleven (42.3%) cases had secondary IPAs, and spinal tuberculosis was the most common underlying condition. Lower-back or flank pain was the most common presentation (69.2%). Computed tomography (CT) scans confirmed all clinical diagnoses. All patients were managed via drainage and antibiotic therapy; seven (26.9%) were subjected to open surgical drainage and 19 (73.1%) received percutaneous drainage (PCD) under ultrasound (US) guidance. The average hospital stay was 9.5 days (range 5-18 days). The hospital stay was significantly shorter in patients treated via PCD compared to those who received open drainage: 8.5 days (range 5-14 days) vs. 12.1 days (range 6-18 days), respectively (p = 0.031). The overall recurrence rate was 11.5% (3/26). Recurrence developed in three patients treated via US-guided PCD and all were successfully treated via a second round of PCD. No mortality was recorded.Conclusions: US-guided PCD combined with appropriate antibiotic therapy is safe and effective with shorter hospital stay when used to treat IPAs. Open surgical drainage may be warranted if the IPA is multiloculated or if there is an underlying pathology.

Epidemiological features and outcomes of patients with psoas abscess: A retrospective cohort study

“…S. aureus was the most common causative bacterium with a higher complication rate of septic shock than other bacteria. The hospital mortality rate was 12%, which was similar to a previous report [ 1 ].…”

“…Previous studies have shown differences in clinical characteristics, treatments, and outcomes between patients with primary and secondary PA [ 2 , 16 , 17 ] as well as between patients with staphylococcal infection and other infections [ 1 , 2 , 18 ]. Therefore, we compared patients with primary and secondary PA and those with staphylococcal infection and other infections.…”

“…Psoas abscess (PA) is an uncommon disorder that is often missed by physicians owing to its nonspecific clinical presentation [ 1 ]. PA can lead to significant morbidity and mortality, with a reported mortality rate of 5–15% and relapse rate of 15.8% [ 1 , 2 ].…”

An Appraisal of Clinical and Hematological Parameters Linked to Recurrence in Surgically Drained Primary Psoas Abscesses: A Retrospective Comparative Study

“…Although the volume of abscess drained in Group B was larger in the present study, it was not statistically significant. There are studies reporting that the drainage time ranged from 2.4 to 45 days in psoas abscesses (18,27). No association was detected in our study between prolonged drainage time and recurrence.…”

Clinical features, management, and outcome of iliopsoas abscess associated with cardiovascular disorders: a hospital-based observational case series study

“…Clinical management with PCD and appropriate antibiotic therapy was safe and effective with shorter hospital stay for IPA. Open surgical intervention might be warranted if there was an underlying pathology [9–11]. Risk factors associated with mortality in IPA caused by CVD were found in our present study to include hypoalbuminemia, hyponatremia, involving disc/vertebral body and/or epidural abscess, and ICU stay with intubation > 3 days.…”