RESUMO
Objective: Abscess of the psoas which was first described by Mynter in 1881[1] is a rare disease. Herein, the authors report on their experience with the treatment of this pathology
Patients and Methods: Between January 1999 and December 2002, 15 patients with abscess of the psoas were seen at our department. They were 12 males [80%] and 3 females [20%] with a mean age of 53 years [range: 27 - 70 years]. Mean hospital stay was 6 weeks [range: 2 - 24 weeks]. All patients were examined by abdominal ultrasonography, 9 by computed tomography. Surgical drainage via a small incision of 5 cm was done in 12 patients, while three patients received medical treatment in combination with a percutaneous drainage
Results: The clinical manifestation included fever in 9 [60%], psoitis in 6 [40%], a mass in the lumbar region in 5 [33%] and an inguinal mass in 3 [20%] patients. Hyperleucocytosis varying between 13000 and 340000/mm[3] was found in all patients. The main organisms isolated were staphylococcus aureus [54%], Koch's bacillus [38.4%], Escherichia coli [15%] and Klebsiella [8%]. De novo abscess of the psoas was found in 4 patients [26.6%], while it was secondary in 11 patients [73.3%]. Surgical drainage of the pus was done via the anterolateral extraperitoneal lumbar approach in 8 patients and via the high inguinal approach in 4 patients. In three patients medical treatment combined with percutaneous drainage was sufficient. The immediate outcome was good in all patients
Conclusion: The pathogenesis of de novo abscess of the psoas is unknown as yet, and its diagnosis remains a challenge for the physician. However, the precise clinical diagnosis and the choice of the therapeutic measures have been facilitated by the development of modern imaging facilities. Surgical treatment should be reserved to those cases where percutaneous drainage has failed