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Updated: Dec 15, 2025
Posterior Approach for Debridement of the Psoas Abscess
Published on: March 2, 2020
Retroperitoneoscopic drainage of cryptogenic psoas abscess
Caterina Froiio1,2, Daniele Tiziano Bernardi2, Emanuele Asti3
1Surgery, Universita degli Studi di Milano, Milano, Italy.
Abstract:
Psoas abscess is a rare and occasionally life-threatening condition. In the past, the major cause of psoas abscess was a descending infection originating from spine tuberculosis (Pott's disease). Subsequently, secondary infection from spondylodiscitis or Crohn's disease has become the prevalent aetiology. Conventional treatment ranges from antibiotic therapy alone to CT-guided and/or surgical drainage. We present the case of a 67-year-old man with a complex history, including pneumonia, sepsis and previous muscle-skeletal trauma. The patient subsequently developed a psoas abscess that was successfully treated with a minimally invasive retroperitoneoscopic approach and antibiotics. Blood cultures and pus yielded Gram-positive Streptococcus sp, and transesophageal echocardiography identified endocarditis as a possible source of sepsis. Postoperative clinical course was complicated by recurrent sepsis that required a change of antibiotic therapy. The patient was eventually discharged to rehabilitation care without further complications. The retroperitoneoscopic approach is safe and effective for the treatment of cryptogenic psoas abscess.
Insights
Psoas abscess, a serious infection, was successfully treated using a minimally invasive retroperitoneoscopic approach and antibiotics. This method offers a safe and effective option for treating cryptogenic psoas abscesses.
Area of Science:
- Infectious Diseases
- Minimally Invasive Surgery
Background:
- Psoas abscess is a rare, potentially life-threatening condition.
- Historically linked to spinal tuberculosis (Pott's disease), current prevalent causes include spondylodiscitis and Crohn's disease.
- Conventional treatments involve antibiotics, CT-guided, or surgical drainage.
Observation:
- A 67-year-old male with a history of pneumonia, sepsis, and trauma developed a psoas abscess.
- Blood cultures and pus identified Gram-positive *Streptococcus* sp.
- Transesophageal echocardiography suggested endocarditis as a potential sepsis source.
Findings:
- The psoas abscess was effectively treated with a minimally invasive retroperitoneoscopic approach and antibiotics.
- The patient experienced recurrent sepsis post-operatively, necessitating a change in antibiotic therapy.
- The retroperitoneoscopic approach demonstrated safety and efficacy in managing this cryptogenic psoas abscess.
Implications:
- Minimally invasive retroperitoneoscopic surgery is a viable and safe treatment for cryptogenic psoas abscess.
- Early identification of underlying causes, such as endocarditis, is crucial for comprehensive patient management.
- This case highlights the successful application of advanced surgical techniques for complex infections.
