Changing etiology of iliopsoas abscess

doi:10.1016/0002-9610(92)90043-Q

The American Journal of Surgery

Volume 163, Issue 4, April 1992, Pages 413-416

https://doi.org/10.1016/0002-9610(92)90043-Q Get rights and content

Abstract

Over a 5-year period, iliopsoas abscesses were found in 11 patients. Although the most common underlying condition was Crohn's disease (3 of 11 patients), 5 abscesses resulted from hematogenous spread from a distant site. Each of these five patients was elderly, severely malnourished, or had an underlying chronic disease. Fever was a presenting sign in 8 of 11 patients, whereas all 4 patients who presented with back pain had nontuberculous lumbar osteomyelitis or disk space infections. No patient presented with the classic triad of fever, back pain, and anterior thigh or groin pain. Computed tomographic (CT) scans accurately established the clinical diagnosis in 10 of 11 patients. Two of the patients died. One patient was an intravenous drug abuser, whereas the other patient was being treated with steroids for systemic lupus erythematosus. Elderly patients, diabetics, and patients with chronic disease are susceptible to this kind of occult infection and may present with minimal clinical findings. Aggressive diagnosis using CT scanning and treatment with resection of involved bowel, complete drainage of the abscess, and prolonged antibiotics are required to salvage these patients.

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Abscesses in the psoas muscle can be primary or secondary in origin. The highly vascular nature of the psoas muscle predisposes it to infection from hematogenous spread, causing primary psoas abscesses, which have been associated with immunosuppression, AIDS, diabetes, renal failure, and intravenous drug use.4 Secondary psoas abscesses arise from a direct local spread of infection from viscera lying along the course of the iliopsoas.
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The incidence while still low in the West is rising especially in those who are immunocompromised. Patients with HIV are particularly at risk.6,7 Trauma to the muscle also appears to be a significant risk factor.
Iliopsoas abscess is a rare condition with a varied symptomology and aetiology. Patients with this condition often present in different ways to different specialities leading to delays in diagnosis and management. Recent advances in the radiological diagnosis of this traditionally rare abscess have highlighted that there is a lack of evidence relating to its aetiology, symptomology, investigation and management. This article reviews the currently available literature to present a concise and systematic review of iliopsoas abscess.
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¹: From the Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

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Scientific paperChanging etiology of iliopsoas abscess

Abstract

Clin Radiol

J Urol

Urology

Tuberculosis of the spine: CT demonstration of paravertebral abscess

Radiologe

Psoas abscess complicating Crohn's disease

Am J Gastrointest

Acute non-tuberculous psoas abscess

Br J Surg

Psoas abscess: changing patterns of diagnosis and etiology

Dis Colon Rectum

Scientific paper
Changing etiology of iliopsoas abscess