A Case of EVAR for Mycotic Aneurysm Rupture / 日本心臓血管外科学会雑誌

We report a case of mycotic aneurysm treated with endovascular aneurysm repair (EVAR). An 80-year-old man was admitted to a local hospital with high fever and lower back pain. Pyogenic spondylitis and psoas muscle abscess were diagnosed. Klebsiella pneumoniae was confirmed by blood culture. Treatment with intravenous antibiotics was not effective and contrast computed tomography (CT) scan showed an enlargement of the abscess and an abdominal aortic rupture. The patient was immediately transferred to our hospital. Laboratory tests showed an elevated C-reactive protein (12.3 mg/dl) and WBC (10,400/μl). Mycotic abdominal aneurysm rupture was diagnosed by CT scan. He underwent an emergency EVAR with an Excluder® (aorta extender). Intraoperative angiography showed a ruptured abdominal aorta. After operation, he was treated with intravenous minocycline and ampicillin, and the size of the abscess reduced without any endoleak on enhanced CT imaging. After intravenous antibiotics therapy for 4 weeks, we switched to oral antibiotics (minocycline and ciprofloxacin) and continued them for 6 months. As of 2 years after the surgery, there are no signs of infection or recurrence.

Clinical Availability, Diagnosis and Treatment of the Primary Psoas Muscle Abscess

STUDY DESIGN: This is a retrospective study on the clinical availability, diagnosis and treatment of primary psoas muscle abscess. OBJECTIVES: This study investigated the causes and clinical results of patients with primary psoas muscle abscess. SUMMARY OF LITERATURE REVIEW: Primary psoas muscle abscess is not a common disease clinically, but it is a very dangerous disease if the diagnosis and treatment are delayed. MATERIALS AND METHODS: Between October 2003 and February 2010, we investigated the symptoms, pathogens, the associated diseases and treatments of 17 patients (11 males and 6 females; mean age: 49.5 years old). We divided patients into the 3 groups According to the treatment options (Group 1: antibiotics alone, Group 2: percutaneous catheter drainage, Group 3: open drainage) and the correlation of the abscess size of each group was analyzed by the Kruskall Wallis method. RESULTS: The most common complaint was lower back pain (14 patients). Staphylococcus aureus was the most common infectious organism (12 patients). All the patients were treated with broad spectrum antibiotics. Group 1 was composed of 4 patients and the average size of the abscess was 2.3cm (range: 1.2~4.5cm). Group 2 was composed of 7 patients and the average size of the abscess was 7.4cm (range: 3.8~12.2cm). Group 3 was composed of 6 patients and the average size of the abscess was 8.1cm (range: 6.1~14.7cm). There was a significant correlation of the abscess size between each group. (p=0.0007) CONCLUSIONS: The patients diagnosed with primary psoas muscle abscess complained about lower back pain, a febrile sense and gastrointestinal symptoms. Most of the primary psoas muscle abscesses are pyogenic infections. We have to use broad-spectrum antibiotics for the initial treatment. When the occasion demands, additional treatment like percutaneous catheter drainage and open drainage should be considered.

A Case of Henoch-Schonlein Purpura with Psoas Muscle Abscess and Full-blown Gastrointestinal Complications / 대한소화기학회지

Henoch-Schonlein purpura (HSP) is a vasculitis involving small vessels of skin, joints, gastrointestinal (GI) tract, and kidneys. The patients typically show palpable purpura with one or more characteristic manifestations including abdominal pain, hematuria or arthritis. HSP shows gastrointestinal symptoms in 50~85% of patients, and in 14~40% of patients GI symptoms precede purpuric rash which makes the diagnosis of HSP difficult. We present a case of Henoch-Schonlein purpura with GI bleeding, septic shock by ileal microperforation, small bowel obstruction as a result of ileal stricture and psoas muscle abscess.