title: Psoas abscess and bacterial peritonitis caused by urinary tract infection in a patient of liver cirrhosis and diabetes mellitus.
abstract: Prognosis of patients with diabetes mellitus or liver cirrhosis can be worsened by the development of a variety of infectious diseases. We describe a case of psoas abscess and bacterial peritonitis in a 58-year-old woman with type C liver cirrhosis and diabetes mellitus hospitalized after having an elevated temperature caused by urinary tract infection for 2 months. The cirrhosis had not been treated and daily self-administration of insulin had been discontinued for the previous 5 months. On day 2 of hospitalization, vomiting and decreased blood pressure developed. Abdominal computed tomography scan revealed ascites, pneumoperitoneum, and psoas abscess. Laparotomy revealed psoas abscess and bacterial peritonitis without gastrointestinal perforation and psoas abscess perforation. Surgical drainage of the abscess and peritoneal cavity was performed. Immediately after the operation, upper gastrointestinal bleeding, shock, hypoglycemia, and metabolic acidosis developed, followed by hepatic failure, renal insufficiency, and cerebral dysfunction. Death occurred on postoperative day 19. Upon autopsy, bacterial peritonitis residue of psoas abscess, and urinary tract infection were confirmed. We surmise that untreated liver cirrhosis and diabetes mellitus is a risk for urinary tract infection that may spread in iliopsoas and free peritoneal space.
authors.affiliation: Department of Surgery, Kagoshima Tokushukai Hospital, Shimoarata 3-8-1, Kagoshima, 890-0056, Japan. kamikado@kanazawa-med.ac.jp.
authors.forename: Chiaki
authors.initials: C
authors.lastname: Kamikado
authors.affiliation: Department of Tumor Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors.forename: Shuuhei
authors.initials: S
authors.lastname: Taguchi
authors.affiliation: Department of Surgery, Kagoshima Tokushukai Hospital, Shimoarata 3-8-1, Kagoshima, 890-0056, Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Wakiyama
authors.affiliation: Department of Surgery, Kagoshima Tokushukai Hospital, Shimoarata 3-8-1, Kagoshima, 890-0056, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Nakamura
authors.affiliation: Department of Surgery, Kagoshima Tokushukai Hospital, Shimoarata 3-8-1, Kagoshima, 890-0056, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Sawatani
authors.affiliation: Department of Tumor Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kawaguchi
authors.affiliation: Department of Tumor Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Umekita
authors.affiliation: Department of Radiology, Kagoshima University School of Medicine, Kagoshima, Japan.
authors.forename: Kouji
authors.initials: K
authors.lastname: Takumi
keywords: Bacterial peritonitis; Diabetes mellitus; Liver cirrhosis; Pneumoperitoneum; Psoas abscess