Iliopsoas Abscess: Presentation, Management, and Outcomes

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Abstract

Background:

Iliopsoas abscess remains a rare condition. Together with a decreasing incidence of tuberculosis infection, pyogenic iliopsoas abscess (PIPA) has become relatively more frequent and represents more than half of iliopsoas abscesses.

Objective:

To analyze presentation, treatment, and outcomes in a series of patients with diagnosis of PIPA.

Design:

Retrospective.

Settings:

A single tertiary care institution.

Patients:

A series of 34 consecutive patients with diagnosis of PIPA treated between 2001 and 2010 at the Hospital Italiano de Buenos Aires.

Main Outcome Measures:

Analyzed variables were: age, sex, diagnostic modality, clinical presentation, and treatment outcomes.

Results:

Primary and secondary abscess occurred in 20.6% and 79.4%, respectively. The leading cause of PIPA was spondylodiscitis (38%) and computed tomography was the preferred diagnostic modality (87%). Most common presentation was left unilateral abscess in 66% of patients and most frequent isolated bacteria were Staphylococcus aureus. Fifteen patients (44%) received antibiotics as initial treatment with an initial failure rate of 80%; 11 of 15 patients required a second treatment. Sixteen patients (47%) underwent percutaneous drainage (PD) as first line treatment with a success rate of 50%. However, success rate of PD, increased to 100% after 2 drainages. Three patients were surgically drained without success (0 of 3 patients). Compared with the rest of the population, PD showed a lower hospital stay (25 vs. 14 d, respectively, P=0.08) whereas surgery had a higher mortality rate (8% vs. 22%, respectively, P=0.03).

Limitations:

A single institutional retrospective study.

Conclusions:

Our series showed a higher proportion of unilateral and secondary abscess. Spondylodiscitis was the first cause of PIPA. PD seems to be the best treatment option for PIPA and compared with surgery it is associated with a higher success rate and lower hospital stay and mortality rate.

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