BACKGROUND Optimal treatment for iliopsoas tendinitis after total hip arthroplasty(THA)with cup malposition,iliopsoas release alone or with cup revision,is controversial,particularly in young,active patients.Moreover,...BACKGROUND Optimal treatment for iliopsoas tendinitis after total hip arthroplasty(THA)with cup malposition,iliopsoas release alone or with cup revision,is controversial,particularly in young,active patients.Moreover,arthroscopic iliopsoas tendon(IPT)release in these patients has been rarely described,and midterm effects of this procedure on THA longevity and groin pain recurrence remain unclear.We performed arthroscopic IPT release after THA and report midterm outcomes in two young patients with acetabular cup malposition.CASE SUMMARY In the two patients,groin pain started early after THA.Physical examination revealed nonspecific findings,and laboratory tests showed no evidence of infection.Radiography and computed tomography showed reduced acetabular component anteversion angle and anterior cup prominence of more than 16 mm.For therapeutic diagnosis,ultrasonography-guided lidocaine with steroid was injected into the IPT sheath.In both patients,groin pain improved initially but worsened after a few months.Therefore,the patients underwent arthroscopic IPT release under spinal anesthesia.Arthroscopy revealed synovitis with fibrous tissues around the IPT and various lesions related to the implants after THA.IPT tenotomy and debridement with biopsy were performed;histopathologic studies showed chronic inflammation with synovial hyperplasia.Both patients were encouraged to start walking immediately after surgery,and they returned to complete daily function early after surgery.They experienced no recurrence of groin pain or any implant-related problems 5 years postoperatively.CONCLUSION Arthroscopic IPT release for cup malposition produced excellent midterm outcomes without recurrence of groin pain and implant-related problems.展开更多
BACKGROUND Postoperative pain following total hip arthroplasty(THA)may occur in a few patients but may pose a significant challenge to surgeons if the etiology is not identified.Herein,we report the case of a patient ...BACKGROUND Postoperative pain following total hip arthroplasty(THA)may occur in a few patients but may pose a significant challenge to surgeons if the etiology is not identified.Herein,we report the case of a patient who developed late-onset pain following THA due to screw penetration of the iliopsoas tendon.CASE SUMMARY We report the case of a 77-year-old man who developed inguinal pain 7 years after THA.While the symptoms resembled that of iliopsoas impingement by the acetabular cup,the pain resolved only when the supplementary acetabular screw protruding through the ilium was decompressed.Decompression was performed using the pararectus approach.The patient was able to ambulate pain-free immediately after surgery.CONCLUSION A protruded screw through the ilium may penetrate the iliopsoas muscle,causing pain following THA.Pain may resolve with the decompression of the protruded screw.展开更多
BACKGROUND Iliopsoas muscle abscess(IPA)and spondylodiscitis are two clinical conditions often related to atypical presentation and challenging management.They are both frequently related to underlying conditions,such...BACKGROUND Iliopsoas muscle abscess(IPA)and spondylodiscitis are two clinical conditions often related to atypical presentation and challenging management.They are both frequently related to underlying conditions,such as immunosuppression,and in many cases they are combined.IPA can be primary due to the hematogenous spread of a microorganism to the muscle or secondary from a direct expansion of an inflammatory process,including spondylodiscitis.Computed tomographyguided percutaneous drainage has been established in the current management of this condition.AIM To present a retrospective analysis of a series of 8 immunocompromised patients suffering from spondylodiscitis complicated with IPA and treated with percutaneous computed tomography-guided drainage and drain insertion in an outpatient setting.METHODS Patient demographics,clinical presentation,underlying conditions,isolated microorganisms,antibiotic regimes used,abscess size,days until the withdrawal of the catheter,and final treatment outcomes were recorded and analyzed.RESULTS All patients presented with night back pain and local stiffness with no fever.The laboratory tests revealed elevated inflammatory markers.Radiological findings of spondylodiscitis with unilateral or bilateral IPA were present in all cases.Staphylococcus aureus was isolated in 3 patients and Mycobacterium tuberculosis in 2 patients.Negative cultures were found in the remaining 3 patients.The treatment protocol included percutaneous computed tomographyguided abscess drainage and drain insertion along with a course of targeted or empiric antibiotic therapy.All procedures were done in an outpatient setting with no need for patient hospitalization.CONCLUSION The minimally invasive outpatient management of IPA is a safe and effective approach with a high success rate and low morbidity.展开更多
Dengue fever is a debilitating mosquito-borne disease caused by dengue virus.We reported a case of femoral compression neuropathy due to iliopsoas hematoma complicating dengue hemorrhagic fever.Iliopsoas muscle hemato...Dengue fever is a debilitating mosquito-borne disease caused by dengue virus.We reported a case of femoral compression neuropathy due to iliopsoas hematoma complicating dengue hemorrhagic fever.Iliopsoas muscle hematoma can cause femoral neuropathy with resultant pain and paralysis.Such manifestations are not well documented in the literature.The pathogenesis of hematoma and compressive neuropathy with its appropriate management is discussed.展开更多
Iliopsoas abscess(IPA) is an uncommon infection. The clinical presentation is usually insidious. Most patients present with nonspecific symptoms, leading to difficulty in prompt and accurate diagnosis. Delay in diagno...Iliopsoas abscess(IPA) is an uncommon infection. The clinical presentation is usually insidious. Most patients present with nonspecific symptoms, leading to difficulty in prompt and accurate diagnosis. Delay in diagnosis can lead to complications, such as sepsis and death. Tattooing has become more popular over the recent years and has been associated with tattooing-related and blood-borne infections. We present two related cases of methicillin-resistant Staphylococcus aureus IPA after tattooing and review the epidemiology, etiology, clinical features, and management of IPA.展开更多
We encountered a patient who developed femoral nerve paralysis due to iliopsoas muscle hematoma. Surgical removal of the hematoma is recommended for such cases, but conservative treatment may also be sufficient and th...We encountered a patient who developed femoral nerve paralysis due to iliopsoas muscle hematoma. Surgical removal of the hematoma is recommended for such cases, but conservative treatment may also be sufficient and there are no clear judgment criteria. An investigation of past reports showed that recovery was faster after surgery than after conservative treatment, regardless of the severity of paralysis, and that hematoma removal was especially effective for cases with severe paralysis. In our case, pain of the femoral nerve-innervated region was rapidly relieved by removal of the hematoma.展开更多
Traumatic iliopsoas hematoma is rare in adolescents. Hematoma within the iliopsoas muscle causes severe pain and dysfunction of the femoral nerve. Surgical treatment is often recommended. Some open surgeries lead to s...Traumatic iliopsoas hematoma is rare in adolescents. Hematoma within the iliopsoas muscle causes severe pain and dysfunction of the femoral nerve. Surgical treatment is often recommended. Some open surgeries lead to severe trauma and some minimally invasive surgeries cannot completely clear the hematoma within the iliopsoas muscle. A new treatment protocol for iliopsoas hematoma is discussed. This report introduces a laparoscopic method as a successful treatment for removing iliopsoas hematomas. Laparoscopic surgery may be a safe and effective alternative to open surgery for hematomas with a mixture of blood clots and old liquid blood.展开更多
We describe a case of right ilio-psoas abscess caused by stump appendicitis 14 years after open appendectomy.Stump appendicitis is a rare complication of appendectomy. Right ilio-psoas abscess was diagnosed in an immu...We describe a case of right ilio-psoas abscess caused by stump appendicitis 14 years after open appendectomy.Stump appendicitis is a rare complication of appendectomy. Right ilio-psoas abscess was diagnosed in an immunecompetent patient and treated by ultrasound guided percutaneous drainage twice without identifying the cause of the abscess. The patient did not improve until diagnostic laparoscopy was performed revealing a long stump appendicitis to be the origin of infection. It was treated by completion appendectomy. Surgical exploration may be necessary in persistent or recurrent ilio-psoas abscesses. We identified 4 reported cases of post-appendectomy ilio-psoas abscess but without recognizing the cause of the abscess and its relation to appendectomy. This is the first reported case of ilio-psoas abscess that developed as a complication of stump appendicitis.展开更多
文摘BACKGROUND Optimal treatment for iliopsoas tendinitis after total hip arthroplasty(THA)with cup malposition,iliopsoas release alone or with cup revision,is controversial,particularly in young,active patients.Moreover,arthroscopic iliopsoas tendon(IPT)release in these patients has been rarely described,and midterm effects of this procedure on THA longevity and groin pain recurrence remain unclear.We performed arthroscopic IPT release after THA and report midterm outcomes in two young patients with acetabular cup malposition.CASE SUMMARY In the two patients,groin pain started early after THA.Physical examination revealed nonspecific findings,and laboratory tests showed no evidence of infection.Radiography and computed tomography showed reduced acetabular component anteversion angle and anterior cup prominence of more than 16 mm.For therapeutic diagnosis,ultrasonography-guided lidocaine with steroid was injected into the IPT sheath.In both patients,groin pain improved initially but worsened after a few months.Therefore,the patients underwent arthroscopic IPT release under spinal anesthesia.Arthroscopy revealed synovitis with fibrous tissues around the IPT and various lesions related to the implants after THA.IPT tenotomy and debridement with biopsy were performed;histopathologic studies showed chronic inflammation with synovial hyperplasia.Both patients were encouraged to start walking immediately after surgery,and they returned to complete daily function early after surgery.They experienced no recurrence of groin pain or any implant-related problems 5 years postoperatively.CONCLUSION Arthroscopic IPT release for cup malposition produced excellent midterm outcomes without recurrence of groin pain and implant-related problems.
基金by Research Fund from Chosun University Hospital,2019。
文摘BACKGROUND Postoperative pain following total hip arthroplasty(THA)may occur in a few patients but may pose a significant challenge to surgeons if the etiology is not identified.Herein,we report the case of a patient who developed late-onset pain following THA due to screw penetration of the iliopsoas tendon.CASE SUMMARY We report the case of a 77-year-old man who developed inguinal pain 7 years after THA.While the symptoms resembled that of iliopsoas impingement by the acetabular cup,the pain resolved only when the supplementary acetabular screw protruding through the ilium was decompressed.Decompression was performed using the pararectus approach.The patient was able to ambulate pain-free immediately after surgery.CONCLUSION A protruded screw through the ilium may penetrate the iliopsoas muscle,causing pain following THA.Pain may resolve with the decompression of the protruded screw.
文摘BACKGROUND Iliopsoas muscle abscess(IPA)and spondylodiscitis are two clinical conditions often related to atypical presentation and challenging management.They are both frequently related to underlying conditions,such as immunosuppression,and in many cases they are combined.IPA can be primary due to the hematogenous spread of a microorganism to the muscle or secondary from a direct expansion of an inflammatory process,including spondylodiscitis.Computed tomographyguided percutaneous drainage has been established in the current management of this condition.AIM To present a retrospective analysis of a series of 8 immunocompromised patients suffering from spondylodiscitis complicated with IPA and treated with percutaneous computed tomography-guided drainage and drain insertion in an outpatient setting.METHODS Patient demographics,clinical presentation,underlying conditions,isolated microorganisms,antibiotic regimes used,abscess size,days until the withdrawal of the catheter,and final treatment outcomes were recorded and analyzed.RESULTS All patients presented with night back pain and local stiffness with no fever.The laboratory tests revealed elevated inflammatory markers.Radiological findings of spondylodiscitis with unilateral or bilateral IPA were present in all cases.Staphylococcus aureus was isolated in 3 patients and Mycobacterium tuberculosis in 2 patients.Negative cultures were found in the remaining 3 patients.The treatment protocol included percutaneous computed tomographyguided abscess drainage and drain insertion along with a course of targeted or empiric antibiotic therapy.All procedures were done in an outpatient setting with no need for patient hospitalization.CONCLUSION The minimally invasive outpatient management of IPA is a safe and effective approach with a high success rate and low morbidity.
文摘Dengue fever is a debilitating mosquito-borne disease caused by dengue virus.We reported a case of femoral compression neuropathy due to iliopsoas hematoma complicating dengue hemorrhagic fever.Iliopsoas muscle hematoma can cause femoral neuropathy with resultant pain and paralysis.Such manifestations are not well documented in the literature.The pathogenesis of hematoma and compressive neuropathy with its appropriate management is discussed.
文摘Iliopsoas abscess(IPA) is an uncommon infection. The clinical presentation is usually insidious. Most patients present with nonspecific symptoms, leading to difficulty in prompt and accurate diagnosis. Delay in diagnosis can lead to complications, such as sepsis and death. Tattooing has become more popular over the recent years and has been associated with tattooing-related and blood-borne infections. We present two related cases of methicillin-resistant Staphylococcus aureus IPA after tattooing and review the epidemiology, etiology, clinical features, and management of IPA.
文摘We encountered a patient who developed femoral nerve paralysis due to iliopsoas muscle hematoma. Surgical removal of the hematoma is recommended for such cases, but conservative treatment may also be sufficient and there are no clear judgment criteria. An investigation of past reports showed that recovery was faster after surgery than after conservative treatment, regardless of the severity of paralysis, and that hematoma removal was especially effective for cases with severe paralysis. In our case, pain of the femoral nerve-innervated region was rapidly relieved by removal of the hematoma.
文摘Traumatic iliopsoas hematoma is rare in adolescents. Hematoma within the iliopsoas muscle causes severe pain and dysfunction of the femoral nerve. Surgical treatment is often recommended. Some open surgeries lead to severe trauma and some minimally invasive surgeries cannot completely clear the hematoma within the iliopsoas muscle. A new treatment protocol for iliopsoas hematoma is discussed. This report introduces a laparoscopic method as a successful treatment for removing iliopsoas hematomas. Laparoscopic surgery may be a safe and effective alternative to open surgery for hematomas with a mixture of blood clots and old liquid blood.
文摘We describe a case of right ilio-psoas abscess caused by stump appendicitis 14 years after open appendectomy.Stump appendicitis is a rare complication of appendectomy. Right ilio-psoas abscess was diagnosed in an immunecompetent patient and treated by ultrasound guided percutaneous drainage twice without identifying the cause of the abscess. The patient did not improve until diagnostic laparoscopy was performed revealing a long stump appendicitis to be the origin of infection. It was treated by completion appendectomy. Surgical exploration may be necessary in persistent or recurrent ilio-psoas abscesses. We identified 4 reported cases of post-appendectomy ilio-psoas abscess but without recognizing the cause of the abscess and its relation to appendectomy. This is the first reported case of ilio-psoas abscess that developed as a complication of stump appendicitis.
