Management and treatment of iliopsoas abscess.
OBJECTIVE
Even with improved diagnostic modalities, the optimum management strategy for iliopsoas abscess (IPA) is not uniform, and a better understanding of treatment options is needed.


METHODS
Retrospective case series.


METHODS
Academic center.


METHODS
Sixty-one consecutive patients diagnosed as having IPA at the Mount Sinai Medical Center, New York, New York, from August 1, 2000, to December 30, 2007.


METHODS
Development and cause of IPA, the need for additional interventions, morbidity, and mortality.


RESULTS
The mean age of the patients was 53 years. Most patients were initially seen with pain (95% [58 of 61]), gastrointestinal tract complaints (43% [26 of 61]), and lower extremity pain (30% [18 of 61]). Primary and secondary abscesses occurred in 11% (7 of 61) and 89% (54 of 61), respectively. The most frequent underlying cause of secondary abscesses was inflammatory bowel disease. Broad-spectrum antibiotics were prescribed in all patients. Computed tomography was the most common diagnostic modality used. Abscesses were larger than 6 cm in 39% of patients (24 of 61), bilateral in 13% (8 of 61), and multiple in 25% (15 of 61). Nine patients were treated using antibiotics alone, with a success rate of 78% (7 of 9). Forty-eight patients initially underwent percutaneous drainage, which was successful in 40% (19 of 48). Among those with unresolved IPAs, 71% of patients ultimately required surgery, and the IPAs were typically associated with underlying gastrointestinal tract causes. Seven percent (4 of 61) of patients directly underwent exploratory surgery and drainage, and all of these interventions were successful. The overall mortality was 5% (3 of 61).


CONCLUSIONS
Iliopsoas abscess remains a therapeutic challenge. Gastrointestinal tract disease is the most common cause, with computed tomography as the diagnostic modality of choice. Percutaneous drainage remains the initial treatment modality but is rarely the sole therapy required. Patients with inflammatory bowel disease are likely to require ultimate operative management.
Division of General Surgery, Department of Surgery, Mount Sinai Medical Center, 5 E 98th St, New York, NY 10029, USA.
Parissa
P
Tabrizian
Scott Q
SQ
Nguyen
Alexander
A
Greenstein
Uma
U
Rajhbeharrysingh
Celia M
CM
Divino
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004322:Drainage; D004927:Escherichia coli Infections / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016659:Psoas Abscess / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents