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
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 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.
