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Psoas abscess complicating Crohn's disease
The American Journal of Gastroenterology
|December 1, 1985
Summary
Psoas abscess can be an early sign of Crohn's disease, even without gastrointestinal symptoms. Combining abscess drainage with bowel resection offers the best treatment outcome for Crohn's disease patients.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Oncology
Background:
- Psoas abscess, historically linked to spinal tuberculosis, is increasingly recognized as a complication of intra-abdominal conditions.
- Crohn's disease is an emerging cause of psoas abscess, with potential for early presentation.
Observation:
- Fever, hip flexion contracture, and weight loss associated with psoas abscess can be the initial manifestations of Crohn's disease.
- Gastrointestinal symptoms may be entirely absent in patients presenting with psoas abscess secondary to Crohn's disease.
- In 11 of 46 reported cases, psoas abscess was the first indicator of underlying Crohn's disease.
Findings:
- Surgical drainage alone resulted in abscess resolution in only 7 of 26 patients.
- Combining surgical drainage with bowel resection achieved initial cure in 14 of 18 patients (77.8%).
- Thromboembolic complications were noted in 8.3% of patients.
Implications:
- Psoas abscess should be considered in the differential diagnosis of unexplained fever and hip pain, particularly in Crohn's disease patients.
- Effective management necessitates a multimodal approach including antibiotics, abscess drainage, bowel resection for fistulizing disease, and antithrombotic prophylaxis.
- Early recognition and comprehensive treatment are crucial for favorable outcomes in Crohn's disease-related psoas abscess.