Silent Shadows: Unveiling the Psoas Abscess and Its Treatment

Iliopsoas abscesses are a rare complication of appendicitis and are associated with high morbidity and mortality without appropriate intervention. Current literature provides sufficient evidence for managing psoas abscesses via antimicrobial therapy, CT-guided percutaneous drainage, and laparoscopic or open drainage as primary approaches. However, there is insufficient data in the current literature for assessing improved patient outcomes with robotically assisted laparoscopic drainage as an approach to treatment. Here, we present the case of a 72-year-old male with a prior history of perforated appendicitis complicated by a pelvic abscess and treated interventional radiology (IR)-guided drain, left partial nephrectomy secondary to renal cell carcinoma, and bilateral hip arthroplasty presenting with signs and symptoms of recurrent appendicitis. CT imaging found a loculated right iliopsoas abscess adjacent to the appendix, which was not amenable to IR percutaneous drainage. Surgical drainage was deemed necessary with a robotically assisted approach, and the patient had improved clinical status after the intervention. Early results show that robotically assisted laparoscopic surgery has been shown to shorten the clinical course for patients via decreased length of stay, faster recovery times, and better incisions cosmetically. Drainage via robotic laparoscopy allows for complete drainage and irrigation, maximizing source control of infection. It is an effective approach for the management of refractory psoas abscesses secondary to appendicitis.