Iliopsoas abscess: presentation, management, and outcomes.

Area of Science:

• Infectious Diseases
• Surgical Pathology
• Radiology

Background:

• Pyogenic iliopsoas abscess (PIPA) is a rare but increasingly frequent condition, often surpassing tuberculous causes.
• PIPA represents over half of all iliopsoas abscesses, highlighting its growing clinical significance.

Purpose of the Study:

• To investigate the clinical presentation, treatment modalities, and patient outcomes for pyogenic iliopsoas abscess.
• To compare the efficacy and safety of different treatment approaches for PIPA.

Main Methods:

• Retrospective analysis of 34 consecutive PIPA patients treated between 2001 and 2010 at a single tertiary care institution.
• Data collected included patient demographics, diagnostic imaging, clinical symptoms, causative pathogens, and treatment outcomes.
• Treatment outcomes were compared between antibiotics, percutaneous drainage (PD), and surgical drainage.

Main Results:

• Spondylodiscitis was the leading cause (38%) of PIPA, with computed tomography being the primary diagnostic tool (87%).
• Percutaneous drainage (PD) demonstrated a 100% success rate after two interventions, with a significantly shorter hospital stay (14 days) compared to surgery.
• Surgical drainage showed a higher mortality rate (22%) than PD (8%).

Conclusions:

• PIPA is frequently unilateral and secondary, with spondylodiscitis as the primary etiology.
• Percutaneous drainage emerges as the preferred treatment for PIPA, offering superior success rates, reduced hospital stays, and lower mortality compared to surgical intervention.