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Updated: May 14, 2026
Posterior Approach for Debridement of the Psoas Abscess
Published on: March 2, 2020
Iliopsoas abscess: presentation, management, and outcomes
Agustin Dietrich1, Hernán Vaccarezza, Carlos A Vaccaro
1Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina. agustin.dietrich@hospitalitaliano.org.ar
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.
Insights
Pyogenic iliopsoas abscess (PIPA) is increasingly common. Percutaneous drainage offers a higher success rate, shorter hospital stay, and lower mortality compared to surgery for PIPA treatment.
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.
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