Psoas abscess secondary to retroperitoneal distant metastases from squamous cell carcinoma of the cervix with thrombosis of the inferior vena cava and duodenal infiltration treated by Whipple procedure: A case report and review of the literature

Abstract

BackgroundPsoas abscess is a rare clinical disease of various origins. Most common causes include hematogenous spread of bacteria from a different primary source, spondylodiscitis or perforated intestinal organs. But rarely some abscesses are related to malignant metastatic disease.Case presentationIn this case report we present the case of a patient with known squamous cell carcinoma of the cervix treated with radio-chemotherapy three years prior. She now presented with a psoas abscess and subsequent complete inferior vena cava thrombosis, as well as duodenal and vertebral infiltration. The abscess was drained over a prolonged period of time and later was found to be a complication caused by metastases of the cervical carcinoma. Due to the massive extent of the metastases a Whipple procedure was performed to successfully control the local progress of the metastasis.ConclusionAs psoas abscess is an unspecific disease which presents with non-specific symptoms adequate therapy may be delayed due to lack of early diagnostic results. This case report highlights the difficulties of managing a malignant abscess and demonstrates some diagnostic pitfalls that might be encountered. It stresses the necessity of adequate diagnostics to initiate successful therapy. Reports on psoas abscesses that are related to cervix carcinoma are scarce, probably due to the rarity of this event, and are limited to very few case reports. We are the first to report a case in which an extensive and complex abdominal procedure was needed for local control to improve quality of life.

Metastatic Cervical Cancer to the Duodenum: A Learning Point

“…Of the 15 cases reported identifying metastatic spread to the bowel [1,[3][4][5][6][7][8][9][10][11][12], three presented with upper gastrointestinal bleeding [1,3], one with small bowel perforation [3], one with a psoas abscess [12], one incidentally [11], and the rest with obstructive symptoms or pain [3][4][5][6][7][8][9][10]. The most common site within the small bowel tends to be the duodenum [1,[3][4][5][6][7][8][9]11] with three cases in the ileum [1] and two in the jejunum [1,10].…”

“…The most common site within the small bowel tends to be the duodenum [1,[3][4][5][6][7][8][9]11] with three cases in the ileum [1] and two in the jejunum [1,10]. Indirect small bowel obstruction via para-aortic lymph nodes caused by cervical metastases has also been reported [3,12].…”

“…Metastatic spread to the duodenum from cervical cancer is rare, with only 15 reported cases in the existing literature identifying metastatic spread to the bowel [1,[3][4][5][6][7][8][9][10][11][12].…”

A case of uterine carcinosarcoma which was strongly suspected to have metastases to the psoas and gluteus muscles

“…Several patients positive for human immunodeficiency virus (HIV) have been reported to have psoas muscle metastasis, most frequently from cervical cancer [6]. Some cases of cervical cancer in HIV-negative patients also have been reported [7][8][9][10]; however, only one case of psoas muscle metastasis from endometrial cancer has been reported [1]. Hematogenous, lymphatic and disseminated spread has been considered as pathways for skeletal muscle metastasis.…”

Malignancy Presenting as a Psoas Abscess

“…In our patient, malignant carcinoma mimicked a psoas abscess and presented with the typical symptoms. Neoplasms like cervical [1], colorectal [2], renal cell [3], and lung carcinomas [4] have been reported to present as psoas abscess.…”