Absceso del psoas ilíaco secundario a un tumor de colon izquierdo fistulizado al retroperitoneo: caso clínico y análisis de la literatura / Iliopsoas abscess resulting from penetrating left colon cancer to the retroperitoneum: case report and literature review / Abscesso do iliopsoas secundário a tumor de cólon esquerdo fistulizado para o retroperitônio: caso clínico e análise da literatura

Los abscesos del psoas ilíaco secundarios a un tumor de colon fistulizado son excepcionales y potencialmente graves. La mayoría son adenocarcinomas de tipo mucinoso. Su tratamiento es complejo ya que, para lograr una resección oncológica pretendidamente curativa, es necesario realizar una resección ampliada con mayor morbimortalidad. Presentamos el caso de una paciente con un adenocarcinoma mucinoso de colon izquierdo fistulizado al músculo ilíaco y la pared anterolateral del abdomen en la que se realizó una resección multivisceral que incluyó el colon izquierdo, el músculo y la cresta ilíaca y parte de la pared anterolateral del abdomen.

Iliopsoas abscess secondary to perforation of colon cancer is an extremely rare and potentially life-threatening condition. Most tumors are mucinous adenocarcinomas. Its treatment its complex, as most patients need radical extended resections to achieve good oncological results, which are in turn, graved with higher morbidity and mortality. We present the case of a patient with a left colon mucinous adenocarcinoma penetrating to the iliopsoas muscle and the anterolateral abdominal wall that required a multivisceral resection including left colon, iliac muscle and crest and part of the anterolateral abdominal wall.

Abscessos do iliopsoas secundários a um tumor de cólon fistulizado são raros e potencialmente graves. A maioria são adenocarcinomas do tipo mucinoso. Seu tratamento é complexo, pois, para se obter uma ressecção oncológica supostamente curativa, é necessário realizar uma ressecção ampliada com maior morbimortalidade. Apresentamos o caso de um paciente com adenocarcinoma mucinoso de cólon esquerdo fistulizado para o músculo ilíaco e parede ântero-lateral do abdome no qual foi realizada ressecção multivisceral que incluiu cólon esquerdo, músculo e crista ilíaca e parte do a parede anterolateral do abdome.

Absceso del psoas ilíaco: importancia del tratamiento percutáneo en una serie consecutiva de casos / Psoas abscess: importance of percutaneous drainage in a consecutive case series

Antecedentes: el absceso del psoas ilíaco es una entidad poco frecuente y de etiología variable. Su ubicación y cuadro clínico inespecífico la convierte en una entidad de difícil diagnóstico para el cirujano general. La oportunidad de tratar una serie de casos en un período de tiempo relativamente corto para este tipo de patología motivan esta comunicación. Objetivo: a partir de una serie consecutiva de casos, analizar etiología, clínica, y enfoque diagnóstico terapéutico, con especial énfasis en el drenaje percutáneo , como así también una sucinta revisión de la bibliografía reciente. Material y métodos: estudio observacional retrospectivo de una serie consecutiva de casos Resultados: la serie consta de 6 casos, 5 de tipo primario y 1 de tipo secundario. La signos más frecuentes fueron el dolor, la impotencia funcional y la leucocitosis. La Tomografía axial computada de abdomen con y sin contraste fue el método diagnóstico de elección. El drenaje percutáneo fue el tratamiento de elección en 5 casos (83,3%) mientras que en el restante se optó por antibioticoterapia y el drenaje de una colección adyacente. La evolución de todos los casos fue favorable. Conclusión: el absceso de psoas ilíaco es una patología que necesita un alto nivel de sospecha dada su clínica inespecífica. Para su diagnóstico, junto acon la clínica la Tomografía es el método de elección. El drenaje percutáneo de las colecciones bajo control tomográfico es un opción segura y eficaz para el tratamiento de esta entidad.

Background: The of the iliopsoas abscess is a rare entity with a variable etiology. Its location and nonspecific clinical features makes it becomes a diagnostic and therapeutic challenge for the general surgeon. The opportunity to treat a series of cases in a relatively short period of time motivates this communication. Objective: From a consecutive case series, we analyze etiology, clinical features , as well as diagnostic and therapeutic approaches, with special emphasis on percutaneous drainage, as well as a brief review of recent literature. Material and methods: Retrospective analysis of a consecutive series of six patients diagnosed with an ilipsoas abscess in a tertiary care center. Results: The series consists of 6 cases, 5 of primary type and 1 of secondary type. Pain, Limp and leucocitosis were the more prevalent signs; computed tomography of the abdomen was the diagnostic method of choice. Percutaneous drainage was the therapeutic option in 5 cases (83.3%), while in the remaining, antibiotic therapy and the drainage of an adjacent collection were indicated. The evolution of all cases was favorable with no mortality nor morbidity. Conclusion: The iliac psoas abscess is a pathology that needs a high level of suspicion given its nonspecific presentation. For diagnosis, together with the clinic, computed tomography is the method of choice. Percutaneous drainage of collection under tomographic control is a safe and effective option for the treatment of this entity.

Absceso de psoas iliaco: un desafío diagnóstico / Psoas-Iliac Abscess a dignotic challengen

El absceso de músculo psoas iliaco se considera una rare-za. Su detección ha mejorado con la utilización de imágenes como la tomografía computada o la resonancia magnética. Presentamos una revisión de casos de absceso de psoas-iliaco internados entre julio de 2015 y febrero de 2018 en un hospital de CABA, Argentina.En este periodo se diagnosticaron un paciente conside-rado de origen primario y ocho de origen secundario. Se observó predominio de colecciones asociadas a es-pondilodiscitis. El síntoma más frecuente fue la fiebre. Staphylococcus aureus fue el germen más rescatado en muestras microbiológicas. Se debe tener alto índice de sospecha de esta patología ante la presencia de fiebre, dolor lumbar y en ocasiones alteración de la marcha. El empleo de antibióticos de amplio espectro sumado a la evacuación de colecciones constituyen la estrategia más efectiva

Psoas-iliac muscle abscess is considered a rarity, the use of images such as computed tomography or magnetic reso-nance imaging has improved its detection.This study reviews cases of psoas-iliac abscess in hospi-talized patients between July 2015 and February 2018 in a hospital in CABA, Argentina.In one of the patients the origin was considered primary ,while in the other eight it was secondary. There was a pre-dominance of collections associated with spondylodiscitis. The most frequent symptom was fever. Staphylococcus au-reus was the most frequent organism obtained in microbio-logical samples. A high level of suspicion must be held in the presence of fever, lumbar pain and sometimes alteration of the gait. The use of broad spectrum antibiotics in addition to evacuation of collections is the most effective strategy.

Absceso del psoas como presentación de tuberculosis vertebral: reporte de un caso / Psoas abscess as spinal tuberculosis presentation: case report

Introducción: El absceso del psoas es un cuadro infrecuente cuyo principal agente etiológico es el Staphyloccocus aureus, y que con baja frecuencia puede ser de etiología tuberculosa como complicación de una afección vertebral por Mycobacterium tuberculosis. Presentación del caso: Mujer de 58 años, mapuche, con antecedentes de enfermedad pulmonar obstructiva crónica y alcoholismo crónico, consultó por cuadro de dos meses de evolución de dolor lumbar, baja de peso y paresia de extremidad inferior derecha que impedía la marcha. Tomografía computada (TC) de columna evidenció espondilodiscitis y absceso del psoas derecho, iniciándose tratamiento antibiótico cubriendo Staphyloccocus aureus. Los hemocultivos y los cultivos de la colección resultaron negativos por lo que se decidió mantener tratamiento ambulatorio. Paciente consultó cuatro meses después por exacerbación de su disnea basal de dos semanas de evolución, radiografía de tórax y TC de tórax de alta resolución compatibles con tuberculosis pulmonar con diseminación miliar bilateral, por lo cual, se inició tratamiento antituberculoso, realizándose baciloscopías que resultaron negativas. Además, se solicitó identificación del bacilo de Koch mediante reacción de polimerasa en cadena que resultó positiva, con lo que se confirmó el diagnóstico de tuberculosis miliar y mal de Pott. Se decidió reevaluar con TC de columna una vez finalizado el tratamiento antituberculoso para decidir conducta quirúrgica. Discusión: Es importante la sospecha activa de etiología tuberculosa ante una espondilodiscitis y un absceso del psoas, pese a su baja frecuencia. El inicio del tratamiento en forma precoz puede modificar la progresión de una infección que puede ser invalidante e incluso mortal.

Introduction: The Psoas abscess is an infrecuent condition which main ethiology is the Staphyloccocus aureus and with less frequency can be a vertebral tuberculosis complication caused by Mycobacterium tuberculosis. Case Report: a 58 years old female, Mapuche, with Chronic Obstructive Pulmonar Disease and chronic alcoholism antecedents, was admitted in the emergency room with a two month old lumbar pain, loss of weight and right inferior extremity paresia which didn't allowed her to walk. The column's Computed Tomography (CT) showed spondylodiscitis and a right psoas abscess, the antibiotherapy, covering Staphyloccocus aureus, was started. The hemoculives and abscess' cultives were negative, so it was decided to continue with ambulatory treatment. The patient was admitted four month later because of two weeks of exacerbation of her basal dysnea. The thorax Radiography and high resolution CT were compatibles with pulmonary tuberculosis with bilateral miliar disemination. Antituberculosis treatment was started, bacilloscopies were negative, also, a Polymerase Chain Reaction identification of Koch's bacillus was performed, resulting positive, confirming the diagnosis of miliar tuberculosis and Pott's disease. Once antituberculosis treatment was finished, a new column's CT was requested to decided surgical conduct. Discussion: Is important to actively suspect of tuberculosis ethiology in presence of spondylodiscitis and psoas abscess, despite it's low frequency. The early treatment start may modify the progresion of an infección that can be invalidating and even mortal.

Derrame pleural como apresentação de abscesso do psoas por Streptococcus anginosus: relato de caso / Pleural effusion as presentation of psoas abscess due to Streptococcus anginosus: case report

O abscesso do psoas traduz uma situação rara, de etiologia variada e fisiopatologia complexa, mas ainda não clarificada. O objetivo deste estudo foi relatar um caso de apresentação rara de abscesso do psoas sob a forma de derrame pleural. Paciente do sexo masculino, 63 anos, com quadro de dispneia e deterioração do estado geral, associado à febre (38,3ºC). Apresentava perda ponderal de 10kg, taquipneia e semiologia pulmonar compatível com derrame pleural direito. Os dados laboratoriais revelaram leucocitose associada à alteração da função hepática, proteína C-reativa e velocidade de sedimentação elevadas. Radiografia do tórax revelou derrame pleural direito. A tomografia computadorizada confirmou a presença de derrame pleural e de abscesso do psoas homolateral, tendo sido iniciada antibioterapia empírica com piperacilina/tazobactam e metronidazol. Realizou, posteriormente, drenagem guiada por tomografia computadorizada do abscesso do psoas. O exame cultural foi positivo para Streptococcus anginosus no líquido pleural, abscesso do psoas e sangue. Após drenagem de abcesso do psoas, foi mantida a imagem compatível com derrame pleural, tendo sido realizada nova drenagem torácica do derrame pleural. Após vários dias, retirou-se a drenagem torácica. Obteve alta hospitalar sendo referenciado à consulta de medicina. Devido à originalidade do caso, visto não existirem casos descritos com essa forma de apresentação, nem por esse agente etiológico, realizou-se uma revisão da literatura do diagnóstico e tratamento dessa doença.

Psoas abscess represents a rare situation of varied etiology and complex pathophysiology that has not yet been clarified. This study aimed to report an unusual presentation of psoas abscesso in the form of pleural effusion. Male patient, 63 years old, with signs of dyspnea and deterioration of general condition, associated with fever (100,94ºF). He presented with 10-kg weight loss, tachypnea, and pulmonary symptomatology that was consistent with right pleural effusion. Laboratory data showed leukocytosis with alteration of liver function, elevated C-reactive protein, and high erythrocyte sedimentation rate. Chest radiograph revealed right pleural effusion. Computed tomography confirmed the presence of pleural effusion and ipsilateral psoas abscess. Empirical antibiotic therapy with piperacillin/tazobactam and metronidazole was initiated, and computed tomography-guided drainage of the psoas abscess was performed. Culture was positive for Streptococcus anginosus in pleural fluid, psoas abscess and blood. After drainage of the psoas abscess, the image that was consistent with pleural effusion remained, and new chest drainage of pleural effusion has been held. After several days, the chest tube was removed. The patient was discharged and referred to clinical consultation. Because of the originality of the case, since there are no cases describing this presentation nor these etiologic agent, literature review of the diagnosis and treatment of this pathology has been conducted

Absceso del psoas tuberculoso, debut en paciente inmunodeprimido: presentación de un caso / Tuberculous psoas abscess, debut in immunocompromised patient: case report

INTRODUCCIÓN: El absceso del psoas (AP) es una patología infrecuente de difícil diagnóstico. Se clasifica en primario o secundario teniendo como factor de riesgo común la inmunodeficiencia. PRESENTACIÓN DEL CASO: Paciente masculino de 40 años sin antecedentes mórbidos. Consulta por cuadro de un mes de evolución caracterizado por dolor lumbar derecho que aumenta al flexionar el muslo ipsilateral. Se asocia compromiso del estado general, dolor abdominal, sensación febril no cuantificada y bradipsiquia. La Tomografía computada (TC) de abdomen y pelvis mostró hipodensidad en relación al músculo psoas derecho diagnosticándose AP primario. El paciente evoluciona con shock séptico, siendo manejado con antibióticos de amplio espectro sin mejoría. Se realizan exámenes generales, Punción lumbar (PL) y Test de Elisa para VIH (TEVIH), resultando la PL compatible con Tuberculosis meníngea y el TE positivo. Se inició tratamiento empírico anti-tísico en espera del cultivo de Koch. Paciente evoluciona favorablemente. Se realiza una TC de control luego de dos semanas de tratamiento, que muestra imagen similar a la inicial, agregándose compromiso vertebral L4-L5, diagnosticándose Enfermedad de Pott (EP) y AP secundario. Se realiza punción y drenaje del absceso y se toma cultivo de Koch que resulta positivo. Paciente evoluciona asintomático, con buena respuesta al tratamiento. DISCUSIÓN: El AP secundario a EP es una entidad poco sospechada. Sin embargo, con métodos diagnósticos como la TC es posible realizar un diagnóstico precoz. Mycobacterium tuberculosis es una causa infrecuente de abscesos del psoas, pero debido al aumento de la población VIH positiva, es probable que aumente su incidencia.

INTRODUCTION: Psoas abscess is an uncommon disease with difficult diagnosis. It can be primary or secondary; immunodeficiency is among risk factors. CASE REPORT: 40 year-old male with no past medical history. He presented to the emergency department with right lumbar pain worsened with flexion of ipsilateral thigh. Involvement of general condition, abdominal pain, unquantified fever and bradypsychia were also present. Computed tomography (CT) scan of the abdomen and pelvis showed an hypodense lesion in the right psoas muscle. Primary psoas abscess was first diagnostic impression. Patient evolved to septic shock and was treated with broad spectrum antibiotics without improvement. General examinations were performed, lumbar puncture supported meningeal tuberculosis and HIV ELISA test was positive. Empirical quintuple therapy for tuberculosis was started before cerebrospinal fluid culture results, with favorable clinical evolution. Control CT scan was similar compared to first one but with L4 – L5 vertebrae involvement. Pott disease and secondary psoas abscess was diagnosed. Koch’s Bacillus culture from abscess puncture were positive. Patient had clinical improvement with antituberculous therapy. DISCUSSION: Psoas abscess is a rarely suspected patology, but with diagnostic methods as CT is possible to make an early diagnosis. Even though Mycobacterium tuberculosis is a rarer cause of psoas abscess, but more cases are expected due to the increased incidence of HIV – positive patients, more cases are expected eventually.

Bilateral paracoccidioidomycotic iliopsoas abscess associated with ileo-colonic lesion / Abscesso paracoccidioidomicótico bilateral do iliopsoas associado ao acometimento íleo-colônico

This case report shows the clinical development of a patient with systemic paracoccidioidomycosis presenting with lymphatic-intestinalmanifestation. The patient initially had a substantial clinical improvement but had a recrudescence after six months of sulfamethoxazoletrimethoprim oral treatment, with the emergence of feverish syndrome, lumbar pain, and intermittent claudication, characterizing a bilateral iliopsoas muscle abscess, necessitating clinicosurgical therapeutics.

Este relato de caso descreve a evolução clínica de paciente comparacoccidioi-domicose sistêmica com manifestação linfática-intestinal.O paciente evoluiu inicialmente com melhora clínica acentuada erecrudescência após seis meses de uso de SMX-TMP pela via oral, com o surgimento de síndrome febril, dor lombar, e claudicação intermitente,caracterizando um abscesso bilateral do músculo íleopsoas, comnecessidade de terapêutica clínico-cirúrgica.

Psoas Abscess Caused by Spontaneous Rupture of Colon Cancer

Spontaneous rupture of colon cancer, combined with psoas abscess formation, is rare. A 44-year-old male visited for back pain and left buttock mass. Abdominal computed tomography and magnetic resonance image revealed a large abscess in the left psoas muscle and in the left lower quadrant area. Ten days after incision and drainage, a skin defect around the left anterior superior iliac spine remained. A local flap was performed using a superficial skin graft. Ten days after the stitches had been removed, fecal discharge was observed around the anterior superior iliac spine at the flap site. An operation was performed by a general surgeon who had diagnosed this as a case of enterocutaneous fistula. Operative findings included a ruptured tumor mass in the descending colon, which was connected to a retroperitoneal abscess. Pathologic report findings determined adenocarcinoma of the resected colon. Herein, we report a case of psoas abscess resulting from perforating colon cancer.

Psoas Abscess Caused by Non-Typhoid Salmonella in a Patient with Severe Aplastic Anemia

The clinical spectrum of infections caused by non-typhoid Salmonella spp. includes gastroenteritis, enteric fever, bacteremia, and extraintestinal localized complications, especially in immunocompromised hosts. Here we report a patient with severe aplastic anemia developing left iliopsoas abscess caused by non-typhoid Salmonella (NTS), which was successfully treated by prolonged antibiotic treatment and repeated debridement. Our data indicate that aplastic anemia is a risk factor for infection caused by NTS.

[Psoas abscess of the adult: study of 38 cases]

Our aim is to report the clinical aspects, the etiologies, the treatment and the evolution of the psoas abscess in the adult. Our retrospective study concerns 38 cases of psoas abscesses collected in the Department of Infectious Diseases of Sfax [Tunisia], over a period of 16 years [January 1990 - December 2005]. The average age is 44 years [extremes: 16-76 years]. The sex-ratio is 1,4. Six patients were diabetics and one had a chronic renal injury at the stage of hemodialysis. The clinical manifestations were: a fever [76,4%], an abdomino-pelvic ache [84,2%] and a psoi'tis [34,2%]. All patients had a biologic inflammatory syndrome with a hyperleucocytosis in 28 cases. The abscess was one-sided in 29 cases and bilateral in 9 cases. After microbiological study and/or histological study, pathogens were identified in 31 patients, they were Staphylococcus aureus [10 cases], Staphylococcus lugdunensis [1 case], Streptococci [3 cases], Escherichia coli [2 cases], Bacteroides fragilis [1 case], Actinomyces [2 cases], Brucella [3 cases], Mycobacterium tuberculosis [8 cases] and Candida glabrata [1 case]. The psoas abscess was primary in 10 cases and secondary in 28 cases. All the patients received an antibiotherapy or an antifungal therapy adapted to the micro-organism in cause, with a drainage of the abscess in 25 cases [surgical in 9 cases and percutaneous in 16 cases]. The evolution was favourable in 36 cases. One patient presented recurrences and one patient died. The psoas abscess of the adult is characterized by a polymorphic clinical presentation. Germs in cause are very variable

A Case of Henoch-Schonlein Purpura with Psoas Muscle Abscess and Full-blown Gastrointestinal Complications / 대한소화기학회지

Henoch-Schonlein purpura (HSP) is a vasculitis involving small vessels of skin, joints, gastrointestinal (GI) tract, and kidneys. The patients typically show palpable purpura with one or more characteristic manifestations including abdominal pain, hematuria or arthritis. HSP shows gastrointestinal symptoms in 50~85% of patients, and in 14~40% of patients GI symptoms precede purpuric rash which makes the diagnosis of HSP difficult. We present a case of Henoch-Schonlein purpura with GI bleeding, septic shock by ileal microperforation, small bowel obstruction as a result of ileal stricture and psoas muscle abscess.

Psoas Abscess Reviewed

Psoas abscesses are rare. In the absence of specific symptoms and signs, their diagnosis was usually difficult. Medical imaging advances have helped in their diagnosis and treatment. Eleven cases of psoas abscess were reviewed retrospectively. We tried to determine epidemiologic and clinical features and therapeutic alternatives for this entity. Mean aged 27 years. Three of the 11 cases occurred in females. An underlying disease was observed in three cases. Associated clinical features were fever [n = 11], lumbar pain [n = 10], and psoOtis [n = 5]. Diagnosis was confirmed by ultrasonography [n = 10] and computed tomography [n = 1]. Blood culture was positive in 6 out of 11 cases: Staphylococcus aureus [n = 5] and Klebsiella pneumonia [n = 1] Staphylococcus aureus was isolated in 6 abscess pus. Antibiotics were prescribed in all cases for a mean length of 61 days, in association with percutaneous drainage in 5 cases, surgical drainage in one case and abscess puncture in one case. Outcome was favourable in all cases, psoas abscess - Staphylococcus aureus - imaging n drainage

Pyogenic psoas abscess: discussion of its epidemiology, etiology, bacteriology, diagnosis, treatment and prognosis - case report

Psoas muscle abscess is a rare condition with vague clinical presentation, which presents a diagnostic challenge requiring a high index of suspicion. We report a case of primary pyogenic psoas abscess caused by Staphylococcus aureus. In this article, the epidemiology, etiology, bacteriological diagnosis and treatment options of this condition are discussed

Psoas abscess-like metastasis from transitional cell carcinoma of urinary bladder.

We report a 70-year-old male who presented with gross painless total haematuria associated with persistent left hip pain of one month duration. Computerised tomography of abdomen revealed a mass on the right lateral wall of urinary and abscess like lesion in the left psoas. He underwent transurethral resection of bladder tumour and ultrasonographical guided tru-cut biopsy of psoas lesion. Histopathology confirmed transitional cell carcinoma with metastasis to left psoas muscle. The presentation highlights the clinical and radiological features along with review of literature of rare metastatic site from transitional cell carcinoma of urinary bladder.

Abceso tuberculoso de psoas: informe de un caso / Tuberculous abscess of the psoas muscle: case report

La tuberculosis es un problema de salud pública, prevalente en México, las manifestaciones extrapulmonares son frecuentes. El psoas se afecta cuando hay ruptura de abscesos de columna toracolumbar (mal de Pott); la afección primaria es rara. Presentamos el caso clínico de un paciente joven, en quien se encontró por cirugía un absceso solitario, granulomatoso primario del psoas derecho, sin lesiones en otro sitio. La etiología tuberculosa fue la más probable, dado los datos clínicos, epidemiológicos, histopatológicos y de imágenes (ultrasonido, tomografía computada, resonancia magnética y gammagrafía). Se inició tratamiento con rifampicina, pirazinamida, etambutol e isoniacida, con buena respuesta durante el seguimiento

El absceso del músculo psoas ilíaco / Psoas iliac muscle abscess

Se relata la experiencia del Hospital Privado de Comunidad en catorce pacientes que sufrieron abscessos del psoas ilíaco, atendidos entre 1983 y 1995. Se trata de una dolencia de diagnóstico difícil como lo sugiere en parte la demora diagnóstica (seis semanas de promedio) y el número y la variedad de diagnósticos diferenciales mencionados al ingresso (promedio de tres por paciente). Predominaron los pacientes de sexo feminino. La fiebre fue el signo más frecuente. El dolor referido al musulo estuvo presente en algo más de la mitad de los enfermos y el signo del psoas se apreció en poco más de un tercio de los mismos. Aun encontrándose este signo no siempre orientó al médico tratante al diagnóstico correcto. De los catorce casos, dos fueron considerados como primarios y doce como secundarios (a osteomielitis, infección urinaria y tumores). La punción del absceso fue de gran utilidad para detectar el germen causal; la utilidad de los hemocultivos fue menor. Predominaron los gérmenes Gram(+) como agentes causales. La TAC fue de gran utilidad cuando se correlacionaba con el cuadro clínico; la ecografía en cambio sólo fue concluyente en un pequeño número de casos. El tratamiento asoció el uso de antibióticos al drenaje por tubo o punción. La mortalidad estuvo vinculada a neoplasias subyacentes.