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Acute pyogenic iliopsoas abscess in Taiwan: clinical features, diagnosis, treatments and outcome.
J Infect. 2000 May; 40(3):248-55.JI

Abstract

OBJECTIVES

To study the variations of aetiology in the patients with acute pyogenic iliopsoas abscess and identify the appropriate diagnostic modalities as well as therapeutic alternatives (e.g. extraperitoneal or retrofascial percutaneous catheter drainage, PCD) other than surgery.

METHODS

We carried out a retrospective review and analysis of 25 patients with acute pyogenic iliopsoas abscess in our institution from August 1988 to July 1998. Blood and urine cultures, imaging studies of the plain films of the abdomen (KUB), ultrasonography (echo) and computed tomography (CT scan) were performed in all patients. The therapeutic regimens included antibiotics only, PCD or aspiration, and surgery.

RESULTS

The male to female ratio was 7: 18. The mean age was 64 years old. Diabetes mellitus (64%) was the dominant predisposing or associated factor. The most common aetiological source was urinary tract infection (52%) with enteric micro-organisms (Escherichia coli: 44% and Klebsiella spp.: 24%). Nineteen patients (76%) had pain in the abdomen, flank or back. Six cases (24%) were classified as 'primary' abscess, and only two patients survived. Nine cases were treated with antibiotics alone, only four responded and the others expired. Of the 15 cases receiving PCD or aspiration, five cases received subsequent surgical drainage or nephrectomy and survived. Another one case of Clostridia gas gangrene received emergency fasciotomy and expired. The total mortality was extremely high (11/25, 44%).

CONCLUSIONS

We concluded that: (i) the aetiology of iliopsoas abscess may vary with the country of origin, with a preponderance of urinary tract infection in our Taiwanese series; (ii) a high index of suspicion is mandatory to enable early diagnosis of acute pyogenic iliopsoas abscess, particularly for older diabetic patients with fever, pain in the abdomen or flank, limp or flexion of the ipsilateral hip; (iii) CT scan can confirm the diagnosis and define the extent of the abscess; (iv) effective management should include appropriate antibiotic therapy and drainage of the abscess; (v) image-guided PCD should be tried first because of its low morbidity. However, should it fail, subsequent surgical drainage should be performed.

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Authors+Show Affiliations

Huang JJ
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, ROC.
Ruaan MK
No affiliation info available
Lan RR
No affiliation info available
Wang MC
No affiliation info available

MeSH

Acute DiseaseAdultAgedAntibiotic ProphylaxisDiabetes ComplicationsDrainageEnterobacteriaceae InfectionsEscherichia coli InfectionsFemaleHumansMaleMiddle AgedPsoas AbscessRetrospective StudiesTaiwanTomography, X-Ray ComputedTreatment OutcomeUrinary Tract Infections

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10908019

Citation

Huang, J J., et al. "Acute Pyogenic Iliopsoas Abscess in Taiwan: Clinical Features, Diagnosis, Treatments and Outcome." The Journal of Infection, vol. 40, no. 3, 2000, pp. 248-55.
Huang JJ, Ruaan MK, Lan RR, et al. Acute pyogenic iliopsoas abscess in Taiwan: clinical features, diagnosis, treatments and outcome. J Infect. 2000;40(3):248-55.
Huang, J. J., Ruaan, M. K., Lan, R. R., & Wang, M. C. (2000). Acute pyogenic iliopsoas abscess in Taiwan: clinical features, diagnosis, treatments and outcome. The Journal of Infection, 40(3), 248-55.
Huang JJ, et al. Acute Pyogenic Iliopsoas Abscess in Taiwan: Clinical Features, Diagnosis, Treatments and Outcome. J Infect. 2000;40(3):248-55. PubMed PMID: 10908019.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute pyogenic iliopsoas abscess in Taiwan: clinical features, diagnosis, treatments and outcome. AU - Huang,J J, AU - Ruaan,M K, AU - Lan,R R, AU - Wang,M C, PY - 2000/7/25/pubmed PY - 2001/2/28/medline PY - 2000/7/25/entrez SP - 248 EP - 55 JF - The Journal of infection JO - J Infect VL - 40 IS - 3 N2 - OBJECTIVES: To study the variations of aetiology in the patients with acute pyogenic iliopsoas abscess and identify the appropriate diagnostic modalities as well as therapeutic alternatives (e.g. extraperitoneal or retrofascial percutaneous catheter drainage, PCD) other than surgery. METHODS: We carried out a retrospective review and analysis of 25 patients with acute pyogenic iliopsoas abscess in our institution from August 1988 to July 1998. Blood and urine cultures, imaging studies of the plain films of the abdomen (KUB), ultrasonography (echo) and computed tomography (CT scan) were performed in all patients. The therapeutic regimens included antibiotics only, PCD or aspiration, and surgery. RESULTS: The male to female ratio was 7: 18. The mean age was 64 years old. Diabetes mellitus (64%) was the dominant predisposing or associated factor. The most common aetiological source was urinary tract infection (52%) with enteric micro-organisms (Escherichia coli: 44% and Klebsiella spp.: 24%). Nineteen patients (76%) had pain in the abdomen, flank or back. Six cases (24%) were classified as 'primary' abscess, and only two patients survived. Nine cases were treated with antibiotics alone, only four responded and the others expired. Of the 15 cases receiving PCD or aspiration, five cases received subsequent surgical drainage or nephrectomy and survived. Another one case of Clostridia gas gangrene received emergency fasciotomy and expired. The total mortality was extremely high (11/25, 44%). CONCLUSIONS: We concluded that: (i) the aetiology of iliopsoas abscess may vary with the country of origin, with a preponderance of urinary tract infection in our Taiwanese series; (ii) a high index of suspicion is mandatory to enable early diagnosis of acute pyogenic iliopsoas abscess, particularly for older diabetic patients with fever, pain in the abdomen or flank, limp or flexion of the ipsilateral hip; (iii) CT scan can confirm the diagnosis and define the extent of the abscess; (iv) effective management should include appropriate antibiotic therapy and drainage of the abscess; (v) image-guided PCD should be tried first because of its low morbidity. However, should it fail, subsequent surgical drainage should be performed. SN - 0163-4453 UR - https://www.unboundmedicine.com/medline/citation/10908019/Acute_pyogenic_iliopsoas_abscess_in_Taiwan:_clinical_features_diagnosis_treatments_and_outcome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0163-4453(00)90643-1 DB - PRIME DP - Unbound Medicine ER -