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Updated: Aug 7, 2025
Posterior Approach for Debridement of the Psoas Abscess
Published on: March 2, 2020
A Case Report of Iliopsoas Abscess Secondary to Small Bowel Fistula
Veronica Guerrero1, Agnes Park2, Steven Y Zhou2
1General Surgery, Northwestern Medicine McHenry Hospital, McHenry, USA.
Abstract:
Iliopsoas abscesses (IPAs) are rare infections in the musculature that can be difficult to diagnose due to nonspecific presentations. These abscesses are most commonly caused by either the hematogenous spread of a separate infectious source in the body or secondary to Crohn's disease and are typically treated with antibiotic therapy and percutaneous drainage. For cases complicated by bowel disease, multiloculated psoas abscess, or gas-forming organisms, surgical drainage may be indicated. We present the case of an 81-year-old female with a history of colon cancer status post-cecum resection who presented with back pain, thigh pain, and constipation. Computerized tomography imaging showed concurrent small bowel obstruction and a right IPA extending down to the right thigh. Laparoscopic exploration revealed a small bowel fistulization to the right iliopsoas as the source of infection. Resection of the small bowel and surgical incision and drainage of the abscess were necessary for her treatment. The patient was discharged with vacuum-assisted closure of her wound after a hospital course complicated with chronic diarrhea. Bowel fistulization should be considered a potential cause of IPAs in patients with a complicated gastrointestinal history.
Insights
Iliopsoas abscesses (IPAs) are rare infections. This case highlights small bowel fistulization as a critical cause of IPAs in patients with gastrointestinal issues, requiring surgical intervention.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Oncology
Background:
- Iliopsoas abscesses (IPAs) are uncommon infections presenting with nonspecific symptoms, often stemming from hematogenous spread or Crohn's disease.
- Standard treatment involves antibiotics and percutaneous drainage, with surgery reserved for complex cases like bowel involvement or multiloculated abscesses.
Observation:
- An 81-year-old female with a history of colon cancer resection presented with back and thigh pain, and constipation.
- CT imaging revealed a right iliopsoas abscess extending to the thigh, concurrent with small bowel obstruction.
Findings:
- Laparoscopic surgery identified small bowel fistulization to the iliopsoas muscle as the source of the IPA.
- Treatment involved small bowel resection and surgical drainage of the abscess, followed by vacuum-assisted wound closure.
Implications:
- Bowel fistulization is a crucial, often overlooked, etiology for iliopsoas abscesses, particularly in patients with a history of gastrointestinal surgery or disease.
- This case underscores the importance of considering gastrointestinal complications in the differential diagnosis of IPAs.
- Prompt surgical intervention may be necessary for IPAs secondary to bowel fistulization.
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