Pyogenic psoas abscess: analysis of 27 cases

Area of Science:

• Infectious Diseases
• Surgical Pathology
• Medical Imaging

Background:

• Pyogenic psoas abscesses present a diagnostic challenge, with varied clinical manifestations and underlying conditions.
• Diabetes mellitus is a significant predisposing factor for pyogenic psoas abscesses.

Purpose of the Study:

• To analyze the clinical characteristics, causative pathogens, treatment outcomes, and associated conditions of pyogenic psoas abscesses.
• To evaluate the efficacy of different management strategies, including percutaneous drainage and surgical debridement.

Main Methods:

• Retrospective review of 29 pyogenic psoas abscess cases in 27 patients treated between 1993 and 1998.
• Diagnosis was primarily based on computed tomography (CT) imaging and confirmed by abscess cultures.
• Analysis of patient demographics, clinical presentation, underlying diseases, microbiological data, and treatment modalities.

Main Results:

• The most common underlying disease was diabetes mellitus. Common symptoms included fever and pain in the flank, back, or hip.
• Staphylococcus aureus was the leading pathogen in primary abscesses, while Escherichia coli predominated in secondary abscesses.
• Percutaneous drainage was performed in 13 patients, surgical debridement in six, with two cases of recurrent abscesses requiring debridement. Mortality occurred in two patients with primary abscesses despite percutaneous drainage.

Conclusions:

• Pyogenic psoas abscesses exhibit diverse clinical presentations and etiologies, with diabetes mellitus being a key risk factor.
• Computed tomography (CT) is crucial for diagnosis, and abscess cultures guide appropriate antibiotic therapy.
• While percutaneous drainage is an option, open drainage remains essential for managing complex abscesses complicated by sepsis.