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Updated: Aug 7, 2026
Posterior Approach for Debridement of the Psoas Abscess
Published on: March 2, 2020
[Psoas abscesses. An up-dated perspective]
Silvia Pérez-Fernández1, Javier de la Fuente-Aguado, Francisco J Fernández-Fernández
1Servicio de Medicina Interna, Complexo Hospitalario Universitario de Vigo, Pontevedra, España. fjfer@mundo-r.com
Objective:
To analyze the characteristics of abscesses of the psoas muscle and assess the differences between pyogenic and tuberculous abscesses.
Methods:
Retrospective descriptive study of all patients with psoas abscess in our hospital over the period 1994 to 2004.
Results:
Fourteen patients were studied (10 males), with a mean age of 42 years. Half of them had had an underlying disease. The most frequent clinical manifestations were abdominal pain (64%), fever (57%), and back pain (43%). All the abscesses were secondary. In 7 patients the origin was gastrointestinal, in 6 osteoarticular, and 1 was related with infection of an aortobifemoral bypass. Computed tomography was the diagnostic imaging method in all patients. Culture of drainage specimens was positive in 92% of patients undergoing this procedure. Causal microorganisms included Mycobacterium tuberculosis (5), Streptococcus intermedius (4), Staphylococcus aureus (3), Escherichia coli (3) and Bacteroides fragilis (2). Tuberculous abscesses originated in spondylitis and the clinical presentation was longer prior to diagnosis. Drainage was performed in 12 patients (8 percutaneous and 4 surgical). Mean duration of antimicrobial therapy was 4 weeks. The infection resolved in all patients.
Conclusions:
Psoas abscess commonly had a gastrointestinal and osteoarticular origin. We underscore the high percentage of tuberculous etiology, which had a more insidious clinical and analytical presentation and was usually secondary to spondylitis. Prolonged antimicrobial treatment associated with drainage was effective therapy.
Insights
Psoas abscesses, often secondary to gastrointestinal or osteoarticular issues, require drainage and prolonged antimicrobial therapy for effective treatment. Tuberculous psoas abscesses present insidiously, typically originating from spondylitis.
Area of Science:
- Infectious Diseases
- Musculoskeletal Infections
- Radiology
Context:
- Psoas abscesses are uncommon but serious infections.
- Understanding their diverse etiologies and clinical presentations is crucial for timely diagnosis and treatment.
- This study analyzes psoas abscess characteristics, differentiating between pyogenic and tuberculous forms.
Purpose:
- To analyze the characteristics of psoas muscle abscesses.
- To assess differences between pyogenic and tuberculous psoas abscesses.
Summary:
- A retrospective study of 14 patients (1994-2004) revealed psoas abscesses are secondary, with common origins in gastrointestinal (7) and osteoarticular (6) systems.
- Clinical manifestations included abdominal pain (64%), fever (57%), and back pain (43%).
- Mycobacterium tuberculosis (5), Streptococcus intermedius (4), Staphylococcus aureus (3), Escherichia coli (3), and Bacteroides fragilis (2) were identified pathogens. Tuberculous abscesses, often from spondylitis, had a more insidious presentation.
Impact:
- Computed tomography is the primary diagnostic tool.
- Drainage (percutaneous or surgical) combined with a mean of 4 weeks of antimicrobial therapy led to complete resolution in all cases.
- Highlights the significant proportion of tuberculous etiology and its distinct presentation, emphasizing the need for prolonged treatment.
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