Retroperitoneoscopic drainage of a psoas abscess

doi:10.1016/j.jpedsurg.2004.05.033

Journal of Pediatric Surgery

Volume 39, Issue 9, September 2004, Pages e4-e5

https://doi.org/10.1016/j.jpedsurg.2004.05.033 Get rights and content

Abstract

Pyogenic psoas abscess in the pediatric age group is a primary condition caused mostly by Staphylococcus aureus. The preferred treatment is percutaneous or surgical drainage under a cover of systemic antibiotics. Laparoscopic drainage scores over open surgery in terms of minimal invasion, shorter hospital stay, better patient comfort, and more complete drainage compared with the percutaneous approach. The authors report a case of a 4-year-old boy with a psoas abscess that was effectively drained laparoscopically through an extraperitoneal approach.

Section snippets

Case report

A 4-years-old boy presented with a 5-day history of fever, limp, and pain in the left loin. He was febrile with tenderness in the left loin and flexor spasm of the left hip joint. The white cell count was 22,000/mm³ with 80% neutrophils. Ultrasonography of the abdomen showed an abscess cavity measuring 5 cm × 5 cm in the region of the left psoas muscle, with a completely inflamed psoas muscle. The patient underwent magnetic resonance imaging (MRI), which confirmed presence of large psoas

Discussion

Psoas muscle abscess is rare and presents a diagnostic challenge with a high index of suspicion.3 It can be primary, from hematologic spread of organisms, or secondary to an infective process in the vicinity. Pyogenic iliopsoas abscess in the pediatric age group is a primary condition caused mostly by S aureus. Other offenders are Escherichia coli and other Enterobacteriaceae.4 Of late, psoas abscesses are only rarely caused by Mycobacterium tuberculosis,4 more so in the developing countries.

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Primary pyogenic abscess of the psoas muscle
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There are more references available in the full text version of this article.

Cited by (16)

Intra-Abdominal, Visceral, and Retroperitoneal Abscesses
2018, Principles and Practice of Pediatric Infectious Diseases
Primary psoas abscess caused by group A streptococcus in a child: Case report with microbiologic findings
2016, Journal of Infection and Chemotherapy
Citation Excerpt :
Secondary cases emerge as a result of direct expansion from surrounding organs [7]. Primary iliopsoas abscess has a good prognosis, with a mortality rate of 2.4%, compared with 18.9% in secondary cases [8]. Staphylococcus aureus is the most common organism in both primary and secondary iliopsoas abscess, while Escherichia coli is frequently found in secondary psoas abscess with a gastrointestinal or urinary tract origin [9].
Primary abscess of the iliopsoas muscle in children is uncommon, especially due to Streptococcus pyogenes (group A streptococcus: GAS), which causes a variety of diseases ranging from pharyngitis to invasive life-threatening infection. We present primary iliopsoas abscess in a nine-year-old boy presenting with fever, mild disturbance of consciousness, limp, and pain in the right loin. Magnetic resonance imaging and isolation of GAS from both blood and abscess samples led us to the confirmative diagnosis. The patient recovered after treatment comprising drainage and intravenous antibiotics. The CovRS system is one of the best-characterized systems with two-component signal transduction in the GAS, and mutations in covRS induce overproduction of various virulence factors that play a crucial role in invasive GAS infection. RopB, also known as a GAS regulator, influences the expression of multiple regulatory networks to coregulate virulence factor expression in GAS. In the present case, sequence analysis revealed the isolated GAS as emm type 6 with alterations in covS, whereas the covR and ropB genes were intact. The covS alterations might have influenced the virulence of the strain causing this severe GAS infection.
Drainage percutané de l'abcès du psoas: Notre expérience et revue de la littérature. Percutaneous drainage of psoas abscess. Our experience and literature review
2014, African Journal of Urology
L’abcès du muscle psoas, infection rétropéritonéale rare et de diagnostic difficile, affecte, des sujets débilités. Le but de notre étude était de rapporter notre expérience du drainage percutané, peu invasive, dans le traitement de cette affection.
Nous rapportons, de façon rétrospective une série de 22 patients suivis au, service d’urologie de l’hôpital militaire Moulay Ismaïl de Meknès (Maroc) sur une période de sept ans, allant de Janvier 2005 et Janvier 2012. Tous les patients avaient eu un drainage percutané de l’abcès, sous guidage échographique ou tomodensitométrique. Une antibiothérapie adaptée était associée au, traitement chirurgical.
Tous les patients avaient une altération de l’état général, 10 (45%) étaient diabétiques., L’évolution postopératoire était constamment favorable. Une récidive de l’abcès a été notée chez deux, patients (9%) traitée favorablement par drainage percutané. Les caractéristiques diagnostiques, cliniques, biologiques et radiologiques de l’affection sont décrites.
Le drainage percutané est une technique facile et fiable. Peu invasive, et pouvant être, répétée en cas de nécessité, elle convient aux patients généralement débilités.
Psoas abscess is a rare retroperitoneal infection and is often difficult to diagnose. It affects debilitated subjects. The aim of our study is to report our experience with percutaneous minimally-invasive drainage in the treatment of this condition.
We report on a retrospective series of 22 patients followed at the Urology service, Military Hospital Moulay Ismail in Meknes (Morocco) over a period of seven years from January 2005 to January 2012. All patients underwent percutaneous drainage of the abscess under guidance of ultrasound or CT, together with appropriate antibiotics.
All patients had constitutional symptoms, 10 (45%) were diabetic. The postoperative course was consistently favorable. Recurrent abscess was noted in two patients (9%) and was favorably treated by percutaneous drainage. Diagnostic, clinical, biological and radiological characteristics of the disease are described.
Percutaneous drainage is an easy and reliable technique. It is minimally invasive, can be repeated if necessary, and is convenient in generally debilitated patients.
Intra-Abdominal, Visceral, and Retroperitoneal Abscesses
2012, Principles and Practice of Pediatric Infectious Diseases, Fourth Edition
Retroperitoneal Laparoscopic Resolution of Posas Abscess: Case Reports and Review of the Literature
2022, Archivos Espanoles de Urologia
Ultrasound-Guided Percutaneous Drainage of Iliopsoas Abscess With Septicemia in an Adolescent: A Case Report and Literature Review
2022, Frontiers in Surgery

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Retroperitoneoscopic drainage of a psoas abscess

Abstract

Section snippets

Case report

Discussion

J Pediatr Surg

J Urol

Primary pyogenic abscess of the psoas muscle

J Bone Joint Surg