Related Experiment Video
Updated: Mar 7, 2026
A Retrospective Study on Endoscopic Surgery for the Treatment of Paravertebral Abscess in Spinal Tuberculosis Patients
Published on: October 25, 2024
Obturator externus abscess in a 9-year-old child: A case report and literature review
Charlotte de Bodman1, Dimitri Ceroni, Justine Dufour
1Pediatric Orthopedics and Traumatology Unit, Lausanne University Hospital, Lausanne Pediatric Orthopedic Service, University Hospitals of Geneva, Geneva Unit of Paediatric Infectious Diseases, Department of Paediatrics, Lausanne University Hospital, Lausanne, Switzerland.
Insights
Obturator pyomyositis is a rare pediatric condition often misdiagnosed. Early MRI and appropriate antibiotic therapy, potentially with surgical intervention for abscesses, are crucial for prompt recovery.
Area of Science:
- Pediatric infectious diseases
- Musculoskeletal infections
- Diagnostic imaging in pediatrics
Background:
- Obturator pyomyositis is a rare pediatric condition with a challenging diagnosis due to its infrequent occurrence and varied presentation.
- Prompt recognition is vital, as it can be mistaken for more common conditions like septic arthritis or osteomyelitis.
- Magnetic Resonance Imaging (MRI) is a highly sensitive tool for diagnosis, complemented by joint fluid aspiration and blood cultures for pathogen identification.
Observation:
- A 9-year-old boy presented with fever, hip pain, and limited range of motion, along with elbow pain and swelling.
- Initial suspicion of septic arthritis in both hip and elbow led to joint aspirations, with pus detected only in the elbow.
- Despite empiric intravenous antibiotics, the patient's symptoms and inflammatory markers persisted.
Findings:
- MRI revealed osteomyelitis of the ischio-pubic area with an associated subperiosteal abscess, confirming obturator pyomyositis.
- Surgical intervention to evacuate the abscess and muscular collection was performed due to persistent symptoms.
- Post-surgical treatment led to significant clinical improvement.
Implications:
- This case highlights the diagnostic difficulties in pediatric pelvic pyomyositis, emphasizing the need for a high index of suspicion.
- Timely and accurate diagnosis, utilizing advanced imaging like MRI, is critical to guide appropriate antibiotic and surgical management.
- Familiarity with this rare condition is essential for clinicians to avoid delayed diagnosis and ensure optimal patient outcomes.
Rationale:
Obturator pyomyositis is a rare condition in children. Diagnosis is often delayed because of its rarity, and the vagaries of its presentation cause it to be easily be missed. Physicians should therefore familiarize themselves with this condition and consider it as a possible differential diagnosis in patients presenting with an acutely painful hip. Inflammatory syndrome is also frequent among sufferers and the MRI is a very sensitive diagnostic tool for obturator pyomyositis. Additionally, joint fluid aspirations and blood cultures are also useful in identifying the pathogen. The appropriate antibiotic therapy provides a rapid regression of symptoms during the early stage of pyomyositis. In cases of MRI-confirmed abscess, surgical treatment is indicated.
Patient Concerns:
Our report focuses on a case of obturator pyomyositis in a 9-year-old boy. The child was febrile for 5 days and could only manage to walk a few steps. His hip range of motion was restricted in all directions. In addition, the patient had presented pain and swelling of his right elbow for a day, with a restriction of motion in the joint. There was a clear inflammatory syndrome. A diagnosis of hip and elbow septic arthritis was suspected, and the child underwent joint aspiration of the both cited joints. The aspiration of the elbow returned pus. Conversely, no effusion was found in the hip aspiration. The administration of empiric intravenous antibiotherapy was started.
Diagnoses:
An MRI revealed an osteomyelitis of the ischio-pubic area associated with a subperiosteal abscess.
Interventions:
Subsequently, 3 days after elbow arthrotomy, a surgical treatment was performed on the patient's right hip in order to evacuate the subperiosteal abscess and muscular collection because of the persistence of the patient's symptoms and inflammatory syndrome despite susceptible intravenous antibiotics. Postsurgery the patient showed steady improvement.
Lessons:
Such cases demonstrate how diagnosis can be difficult because pelvic pyomyositis is often mistaken for more common pathologies such as septic arthritis, osteomyelitis, or appendicitis. This may delay the diagnosis or refer misdiagnosis. We discuss this rare infection in light of the literature with particular reference to its incidence, clinical features, bacteriological etiology, biological, and radiological presentation, and above all, its treatment.
