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Should We Routinely Exclude Retroperitoneal Abscess in Cases of Hip Periprosthetic Joint Infections?
Efstratios D Athanaselis1, Fotios Papageorgiou1, Nikolaos Stefanou1
1Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, GRC.
Abstract:
Hip periprosthetic joint infections (PJIs) with concomitant retroperitoneal abscesses may not be common clinical situations but they can be easily misdiagnosed affecting the effectiveness of infection control and eradication interventions. We present the case of a 75-year-old female patient with a late hip PJI complicated with iliopsoas abscess that was barely discovered intraoperatively. Literature review supports our recommendation of a high index of suspicion in cases of hip PJI and even routinely imaging examination of pelvis and abdomen for retroperitoneal involvement exclusion.
Insights
Hip periprosthetic joint infections (PJIs) with retroperitoneal abscesses are rare but easily misdiagnosed. Early diagnosis is crucial for effective treatment of these challenging hip infections.
Area of Science:
- Orthopedics
- Infectious Diseases
- Radiology
Background:
- Periprosthetic joint infections (PJIs) are serious complications following hip replacement surgery.
- Retroperitoneal abscesses, particularly iliopsoas abscesses, can present as rare but challenging comorbidities.
- Misdiagnosis of concomitant infections can impede timely and effective management.
Observation:
- A 75-year-old female patient presented with a late hip PJI.
- The hip PJI was complicated by an undiagnosed iliopsoas abscess, discovered incidentally during intraoperative examination.
- The retroperitoneal involvement was not suspected prior to surgery.
Findings:
- The case highlights the potential for hip PJI to be associated with occult retroperitoneal abscesses.
- Delayed or missed diagnosis of the retroperitoneal component can compromise treatment outcomes.
- A high index of suspicion is warranted in patients with hip PJI.
Implications:
- Routine imaging of the pelvis and abdomen should be considered for patients with hip PJI to exclude retroperitoneal involvement.
- Enhanced diagnostic vigilance can improve infection control and eradication strategies for complex PJIs.
- This case underscores the importance of comprehensive evaluation in suspected hip PJI cases.
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