Surgical Management of Primary Iliopsoas Abscess

PURPOSE: An Incidence of primary iliopsoas abscess is extremely rare. So it's clinical features are unclear. We reported the clinical features and treatment of primary iliopsoas abscess with reference review. METHODS: The ten cases of primary iliopsoas abscess from January 1999 to August 2003 were included in this study. We analyzed clinical manifestation, diagnostic modality, treatment and prognosis retrospectively. Microbiologic study and imaging study were performed in all patients. The treatments included surgical drainage, percutaneous drainage, and systemic antibiotics only were performed. RESULTS: In demographics of patient, the sex ratio was equal and mean age was 51.8 years old with predominant elderly (more than 60 years old). The abscess was confirmed by computed tomography in 8 patients, magnetic resonance imaging in 1. One abscess was found after laparotomy. The one side iliopsoas abscess was found in eight cases (right 4 cases and left 4) and bilateral abscess was in two cases. All cases were multilobulated abscess. After failure of percutaneous drainage, surgical drainage with retroperitoneal approach was performed in 8 patients. Transperitoneal drainage and systemic antibiotics therapy without drainage was respectively performed in one case. One case of abscess was recurred due to early removal of drain and insufficient antibiotics therapy. Other nine patients were completely resolved without complication or mortality. CONCLUSION: The diagnosis of primary iliopsoas abscess requires a high index of suspicion due to its rarity. If we consider that most iliopsoas abscess was multi-lobulated, early surgical drainage with sufficient administration of systemic antibiotics is an effective treatment modality.

Primary Iliopsoas Abscess due to Staphylococcus aureus: 3 cases reports

Primary iliopsoas abscess, without a causative infection focus, is a very rare kind of retroperitoneal abscess. Immunocompromised patient, such as elderly patients, diabetics and patients with chronic disease, are susceptible to this kind of infection. Because early diagnosis of priiliopsoas abscess is usually delayed due to nonspecific clinical presentation, proper treatment is also delayed which causes high mortality and morbidity. Recently we experienced three cases of primary iliopsoas abscess due to Staphylococcus aureus. Diagnosis of these cases was belatedly confirmed by using a abdominal-pelvic computerized tomography (CT) scan. Open surgical drainage via an extraperitoneal approach and administration of appropriate systemic antibiotics were required to save these patients. Based on a review of the literature, we evaluated the diagnosis and treatment of primary iliopsoas abscess.