Iliopsoas abscesses: diagnostic, aetiologic and therapeutic approach in five patients with a literature review.
OBJECTIVE
Iliopsoas abscess is a relatively rare disease. Many cases present atypical clinical characteristics. Iliopsoas abscess can be primary or secondary to gastrointestinal and genitourinary infections and in developed countries most of these abscesses are of non-tuberculous aetiology. A high index of clinical suspicion, the past and recent history of the patient and imaging studies can be helpful in diagnosing the disease. Early treatment with drainage, surgery or appropriate antibiotic therapy is necessary before the sepsis becomes lethal. The purpose of the study was to present five cases with iliopsoas abscesses based on the rarity of this clinical entity.


METHODS
Five cases with iliopsoas abscess, treated during the past 10 years were analysed retrospectively, with emphasis on the diagnostic and therapeutic approach to the disease.


RESULTS
Three out of five cases were primary abscesses; one was of tuberculous aetiology and one secondary to bowel perforation due to a tumour. Staphylococcus aureus was the main bacterium in primary abscesses. Percutaneous drainage with administration of appropriate antibiotics was the main treatment. The secondary psoas abscess was treated successfully with surgery. Owing to long-standing septic and atypical symptoms before admission, one case had a lethal course, despite the early hospital diagnosis and treatment.


CONCLUSIONS
The aetiology of iliopsoas abscess can vary, disposing to a high index of suspicion. Imaging studies can confirm the diagnosis early, and differentiation between primary and secondary type determines the most appropriate kind of treatment.
Charalampopoulos
Anestis
A
Third Department of General Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece.
Macheras
Anastasios
A
Charalabopoulos
Alexandros
A
Fotiadis
Constantin
C
Charalabopoulos
Konstantinos
K
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000628:therapy; D016659:Psoas Abscess / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000628:therapy
D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents