Laparoscopic Drainage of Bilateral Tuberculous Psoas Abscesses

Abstract

Psoas abscess secondary to Mycobacterium tuberculosis infection is rare in industrialized countries. Standard treatment options for psoas abscess of any etiology include percutaneous drainage under radiographic guidance and surgery, which is reserved for failure of conservative therapy. A case of bilateral tuberculous psoas abscesses is reported and a surgical method of drainage utilizing a totally extraperitoneal laparoscopic approach is described.

Retroperitoneoscopic drainage of complicated psoas abscesses in patients with tuberculous lumbar spondylitis

“…In previous published articles, about retroperitoneoscopic procedures, various complications and failed attempts have been reported [3,10,21,22]. In a series of 600 urological cases, the authors have reported complication rates of 5.3% including bleeding or hematoma, and conversion rates to open surgery of 4.6% [3].…”

“…In a series of 600 urological cases, the authors have reported complication rates of 5.3% including bleeding or hematoma, and conversion rates to open surgery of 4.6% [3]. In a orthopedic series of 20 cases, the three cases with bleeding and one case with peritoneum penetration has been reported [10]. However, with increasing experience the complication rates decrease [22].…”

“…The fascia of the psoas muscle with posterior perirenal fascia is anatomically placed in the retroperitoneal space [9], so we had thought that retroperitoneoscopic drainage can be used instead of open surgical drainage for psoas abscesses. To our knowledge, only two publications regarding endoscopic drainage of psoas abscess were reported in the English literature [10,11].…”

Laparoscopic Drainage of Iliopsoas Abscess

“…However, surgery has been recommended as the first-line treatment in secondary abscesses when the gastrointestinal tract is confirmed as the source of sepsis, as it allows definitive management of the pathologic bowel as well as full debridement of infected tissue. 10 The standard surgical technique involves an open approach incorporating a right iliac fossa incision and a muscle-splitting dissection, continued posteriorly in the extraperitoneal plane until the psoas muscle is exposed. 10 There are other approaches, including groin, thigh, and lumbar incisions, but these approaches have been associated with unacceptable failure rates.…”

“…10 The standard surgical technique involves an open approach incorporating a right iliac fossa incision and a muscle-splitting dissection, continued posteriorly in the extraperitoneal plane until the psoas muscle is exposed. 10 There are other approaches, including groin, thigh, and lumbar incisions, but these approaches have been associated with unacceptable failure rates. 10 Laparoscopic drainage has advantages over open surgery, including potentially better visualization of the area, more complete drainage, reduced postoperative pain, and shorter hospital stay.…”