Pyogenic Psoas Abscess: Difficulty in Early Diagnosis

Abstract

Aim: To report on the clinical features, diagnosis, and treatment of psoas abscess (PA) with special attention to the presence of septic shock. Patients and Methods: This study included 17 patients (mean age 66.2, range 43–81 years) with PA. Treatment consisted of intravenous administration of antibiotics and abscess drainage, either surgical or percutaneous with ultrasound guidance. Results: The typical patients presented with fever >38°C (16/17, 94%), pain in back, flank, or abdomen (15/17, 88%), hip flexion contracture with pain extension (14/17, 82%), and mass felt in the flank (5/17, 29%). All 8 patients without septic shock (100%) had the clinical triad (fever, pain in back, flank, or abdomen, and hip flexion contracture) as compared with 4 of 9 patients with septic shock (44%) (p = 0.012). The duration of symptoms before hospitalization was significantly shorter in the patients with septic shock (median 2, range 1–5 days) than in those without septic shock (median 18.5, range 11–63 days; (p = 0.0005). The mortality rates were 33% (3 of 9) and 0% (0 of 8) in the patients with and without septic shock, respectively (p = 0.071). Conclusions: PA patients with septic shock had a tendency to have nonspecific symptoms and an occult clinical course as compared with those without septic shock. A delay in diagnosis and treatment can result in a worse clinical outcome (death or totally disabled state). Increased awareness of this condition should lead to earlier diagnosis and treatment with improved outcomes.

Increasing incidence of iliopsoas abscesses with MRSA as a predominant pathogen

“…19 The non-specific nature of symptoms in occult infection often leads to delays in diagnosis and appropriate management. 20 In this series, fever, back pain, and abdominal pain were the most common presenting symptoms. Inflammatory markers tended to be elevated in most patients.…”

Laparoscopic Drainage of Iliopsoas Abscess

“…Percutaneous drainage was first described in 1984, 6 and case series have reported a success rate of 70% to 90%. 8,9 The limitation of percutaneous drainage is incomplete drainage of the abscess cavity, especially in a multiloculated abscess. Therefore, percutaneous drainage guidance has been suggested as the first-line treatment, with open surgery being reserved for complex, multiloculated abscesses or after failure of the percutaneous technique.…”

Use of omental pedicles in mycotic abdominal aortic aneurysm repair

“…4 There are few previously cases of aortic infection complicated by a psoas abscess and the incidence of psoas abscess in patients with a mycotic aortic aneurysm has been reported at 4-20%. [5][6][7][8][9][10][11][12][13] Ideally, before surgery is undertaken, the patient should be apyrexial, blood cultures sterile and inflammatory markers normal. Surgical management in the form of wide debridement and resection of the infected aorta and the surrounding infected tissue followed by distal revascularization together with long-term antibiotics has been the standard treatment.…”