Retrofascial nontuberculous psoas abscess

Abstract

Psoas abscess is usually associated with tuberculous spondylitis, but also occurs in relation to inflammatory bowel disease. We present 17 cases of primary pyogenic psoas abscess seen during a 10 year period at the King Fahd Hospital, Al-Khobar. There were 13 males and 4 females with a mean age of 24.9 years (range one to 55 years). Five patients had sickle cell disease. The average delay in presentation was 4.5 weeks (range 2 to 9 weeks). Pyrexia and a painful hip with a flexion deformity were the most obvious signs. The sedimentation rate and white cell count were markedly raised in every case. Staphylococci were cultured in 10 and anaerobic streptococci, salmonella and E coli in 2 each. Ultrasonography, CT and MR imaging were used to confirm the diagnosis. Early recognition and drainage are important to ensure a rapid recovery.

Primary pyogenic abscess of the psoas muscle

“…Pus may also enter the adductor angle and cause pain in the proximal part of the thigh. In Anaemia, leucocytosis with a shift to the left and an elevated ESR are common [2,3,5,7]. In our series, 8 patients had leucocytosis, one had anaemia, and the ESR was elevated in each.…”

“…The anterior border of the iliopsoas fascia is also termed the ªtrans-versalis fasciaº and anterior to the transversalis fascia is the retroperitoneal space. A pyogenic psoas abscess is a retrofascial infection rather than a retroperitoneal infection [2]. Up until 1993, only 434 cases had been reported, of which 315 were primary (72.6%) [3,4].…”