title: Psoas abscess rarely requires surgical intervention.
abstract: 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.
authors.affiliation: Division of Emergency Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California 90033, USA.
authors.forename: Wael N
authors.initials: WN
authors.lastname: Yacoub
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Sohn
authors.forename: Sirius
authors.initials: S
authors.lastname: Chan
authors.forename: Mikael
authors.initials: M
authors.lastname: Petrosyan
authors.forename: Hope M
authors.initials: HM
authors.lastname: Vermaire
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Kelso
authors.forename: Shirin
authors.initials: S
authors.lastname: Towfigh
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Mason
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents