Psoas abscess rarely requires surgical intervention.
BACKGROUND
Surgeons are increasingly encountering psoas abscesses.


METHODS
We performed a review of 41 adults diagnosed and treated for psoas abscess at a county hospital. Treatment modalities and outcomes were evaluated to develop a contemporary algorithm.


RESULTS
Eighteen patients had a primary psoas abscess, and 23 had a secondary psoas abscess. Patient characteristics were similar in both groups. Intravenous drug abuse was the leading cause of primary abscesses. Secondary abscesses developed most commonly after abdominal surgery. Treatment was via open drainage (3%), computed tomography-guided percutaneous drainage (63%), or antibiotics alone (34%). Four recurrences occurred in the percutaneous group. Statistical analysis showed that the median size of psoas abscesses in the percutaneous group was significantly larger than in the antibiotics group (6 vs 2 cm; P < .001). The mortality rate was 3%.


CONCLUSIONS
Initial management of psoas abscesses should be nonsurgical (90% success). Small abscesses may be treated with antibiotics alone, and surgery can be reserved for occasional complicated recurrences.
Yacoub
Wael N
WN
Division of Emergency Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California 90033, USA.
Sohn
Helen J
HJ
Chan
Sirius
S
Petrosyan
Mikael
M
Vermaire
Hope M
HM
Kelso
Rebecca L
RL
Towfigh
Shirin
S
Mason
Rodney J
RJ
D000328:Adult; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016659:Psoas Abscess / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D015641:Radiography, Interventional; D012008:Recurrence; D012307:Risk Factors; D013211:Staphylococcus aureus / Q000302:isolation & purification; D015819:Substance Abuse, Intravenous / Q000150:complications; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents