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Management and treatment of iliopsoas abscess.
Arch Surg. 2009 Oct; 144(10):946-9.AS

Abstract

HYPOTHESIS

Even with improved diagnostic modalities, the optimum management strategy for iliopsoas abscess (IPA) is not uniform, and a better understanding of treatment options is needed.

DESIGN

Retrospective case series.

SETTING

Academic center.

PATIENTS

Sixty-one consecutive patients diagnosed as having IPA at the Mount Sinai Medical Center, New York, New York, from August 1, 2000, to December 30, 2007.

MAIN OUTCOME MEASURES

Development and cause of IPA, the need for additional interventions, morbidity, and mortality.

RESULTS

The mean age of the patients was 53 years. Most patients were initially seen with pain (95% [58 of 61]), gastrointestinal tract complaints (43% [26 of 61]), and lower extremity pain (30% [18 of 61]). Primary and secondary abscesses occurred in 11% (7 of 61) and 89% (54 of 61), respectively. The most frequent underlying cause of secondary abscesses was inflammatory bowel disease. Broad-spectrum antibiotics were prescribed in all patients. Computed tomography was the most common diagnostic modality used. Abscesses were larger than 6 cm in 39% of patients (24 of 61), bilateral in 13% (8 of 61), and multiple in 25% (15 of 61). Nine patients were treated using antibiotics alone, with a success rate of 78% (7 of 9). Forty-eight patients initially underwent percutaneous drainage, which was successful in 40% (19 of 48). Among those with unresolved IPAs, 71% of patients ultimately required surgery, and the IPAs were typically associated with underlying gastrointestinal tract causes. Seven percent (4 of 61) of patients directly underwent exploratory surgery and drainage, and all of these interventions were successful. The overall mortality was 5% (3 of 61).

CONCLUSIONS

Iliopsoas abscess remains a therapeutic challenge. Gastrointestinal tract disease is the most common cause, with computed tomography as the diagnostic modality of choice. Percutaneous drainage remains the initial treatment modality but is rarely the sole therapy required. Patients with inflammatory bowel disease are likely to require ultimate operative management.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Tabrizian P
Division of General Surgery, Department of Surgery, Mount Sinai Medical Center, 5 E 98th St, New York, NY 10029, USA.
Nguyen SQ
No affiliation info available
Greenstein A
No affiliation info available
Rajhbeharrysingh U
No affiliation info available
Divino CM
No affiliation info available

MeSH

AdolescentAdultAgedAged, 80 and overAnti-Bacterial AgentsCohort StudiesCombined Modality TherapyDrainageEscherichia coli InfectionsFemaleHumansMaleMiddle AgedPsoas AbscessRetrospective StudiesStaphylococcal InfectionsTreatment OutcomeYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19841363

Citation

Tabrizian, Parissa, et al. "Management and Treatment of Iliopsoas Abscess." Archives of Surgery (Chicago, Ill. : 1960), vol. 144, no. 10, 2009, pp. 946-9.
Tabrizian P, Nguyen SQ, Greenstein A, et al. Management and treatment of iliopsoas abscess. Arch Surg. 2009;144(10):946-9.
Tabrizian, P., Nguyen, S. Q., Greenstein, A., Rajhbeharrysingh, U., & Divino, C. M. (2009). Management and treatment of iliopsoas abscess. Archives of Surgery (Chicago, Ill. : 1960), 144(10), 946-9. https://doi.org/10.1001/archsurg.2009.144
Tabrizian P, et al. Management and Treatment of Iliopsoas Abscess. Arch Surg. 2009;144(10):946-9. PubMed PMID: 19841363.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management and treatment of iliopsoas abscess. AU - Tabrizian,Parissa, AU - Nguyen,Scott Q, AU - Greenstein,Alexander, AU - Rajhbeharrysingh,Uma, AU - Divino,Celia M, PY - 2009/10/21/entrez PY - 2009/10/21/pubmed PY - 2009/12/16/medline SP - 946 EP - 9 JF - Archives of surgery (Chicago, Ill. : 1960) JO - Arch Surg VL - 144 IS - 10 N2 - HYPOTHESIS: Even with improved diagnostic modalities, the optimum management strategy for iliopsoas abscess (IPA) is not uniform, and a better understanding of treatment options is needed. DESIGN: Retrospective case series. SETTING: Academic center. PATIENTS: Sixty-one consecutive patients diagnosed as having IPA at the Mount Sinai Medical Center, New York, New York, from August 1, 2000, to December 30, 2007. MAIN OUTCOME MEASURES: Development and cause of IPA, the need for additional interventions, morbidity, and mortality. RESULTS: The mean age of the patients was 53 years. Most patients were initially seen with pain (95% [58 of 61]), gastrointestinal tract complaints (43% [26 of 61]), and lower extremity pain (30% [18 of 61]). Primary and secondary abscesses occurred in 11% (7 of 61) and 89% (54 of 61), respectively. The most frequent underlying cause of secondary abscesses was inflammatory bowel disease. Broad-spectrum antibiotics were prescribed in all patients. Computed tomography was the most common diagnostic modality used. Abscesses were larger than 6 cm in 39% of patients (24 of 61), bilateral in 13% (8 of 61), and multiple in 25% (15 of 61). Nine patients were treated using antibiotics alone, with a success rate of 78% (7 of 9). Forty-eight patients initially underwent percutaneous drainage, which was successful in 40% (19 of 48). Among those with unresolved IPAs, 71% of patients ultimately required surgery, and the IPAs were typically associated with underlying gastrointestinal tract causes. Seven percent (4 of 61) of patients directly underwent exploratory surgery and drainage, and all of these interventions were successful. The overall mortality was 5% (3 of 61). CONCLUSIONS: Iliopsoas abscess remains a therapeutic challenge. Gastrointestinal tract disease is the most common cause, with computed tomography as the diagnostic modality of choice. Percutaneous drainage remains the initial treatment modality but is rarely the sole therapy required. Patients with inflammatory bowel disease are likely to require ultimate operative management. SN - 1538-3644 UR - https://www.unboundmedicine.com/medline/citation/19841363/Management_and_treatment_of_iliopsoas_abscess_ DB - PRIME DP - Unbound Medicine ER -