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Iliopsoas Abscess: Presentation, Management, and Outcomes Agustin Dietrich, MD,* Herna´n Vaccarezza, MD,w and Carlos A. Vaccaro, MD, PhDw
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. Key Words: iliopsoas abscess, percutaneous drainage, surgery
(Surg Laparosc Endosc Percutan Tech 2013;23:45–48) irst described by Mynter in 18811 as a complication of tuberculous infection of spine or sacroiliac joints, iliopsoas abscess (IPA) remains a rare condition. Nowadays,
with the development of modern antibiotic therapy and a decreasing incidence of tuberculosis and Pott disease, pyogenic nontuberculous iliopsoas abscess (PIPA) has become more frequent.2 Traditionally, PIPA can be divided into primary and secondary depending on its etiology. Primary PIPA arises from hematogenous spread from a known septic focus and it is commonly seen in young patients from developing countries. On the other hand, secondary abscesses are associated with other underlying conditions and are typically observed in Europe and North America. Classic symptoms described by Mynter as fever, limp, and back pain are rarely seen.3 Its diagnosis represents a challenge for surgeons and it is mainly based on imaging ﬁndings. Despite the development of new surgical techniques, such as percutaneous drainage (PD), the optimal management remains not well established. Most case reports come from European and Asian countries and there is a lack of data from South America. The aim of this study was to assess clinical features, management, and surgical outcomes of PIPA in a referral centre from Argentina.
MATERIALS AND METHODS All consecutive patients with diagnosis of PIPA treated between 2001 and 2010 at the Hospital Italiano de Buenos Aires were analyzed. Data were obtained from a retrospectively maintained database. The treatment algorithm was based on physician judgment at the time of intervention. Patients were divided into 3 treatment arms according to the ﬁrst line of treatment used: antibiotics, PD, or surgical drainage (CX).
Diagnosis and Selection Criteria The diagnosis of IPA was done by imaging [ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI)], by purulent discharge after a PD, or as an intraoperative ﬁnding. Inclusion criteria for PD was any abscess with easy and safe access, well circumscribed, and >3 cm. Exclusion criteria were patients with an inﬂammatory mass (ie, dense and homogenously enhancing soft tissue on CT), abscess