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Posterior Approach for Debridement of the Psoas Abscess
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Iliopsoas Abscesses: Whose Problem is it? Insights Gained by an Institutional 100-Patient Consecutive Case Series
Youssef J Hamade1, Elizabeth Ogando-Rivas1, Zachary L Tataryn2
1St. Elizabeth Medical Center at Boston University, Department of Neurosurgery, Brighton, Massachusetts, USA.
World Neurosurgery
|April 16, 2025
Summary
Iliopsoas abscess (IPA) management combines antibiotics and CT-guided percutaneous drainage (PCD) as first-line treatments. Surgery is reserved for complex cases or treatment failures, with a 5% mortality rate observed in this study.
Area of Science:
- Infectious Diseases
- Radiology
- Surgical Sciences
Background:
- Iliopsoas abscess (IPA) is a rare but severe infection.
- It arises from hematogenous or contiguous spread.
- Standard management includes antibiotics and drainage for larger abscesses.
Purpose of the Study:
- To analyze the clinical features, treatment strategies, and outcomes of iliopsoas abscess (IPA).
- To evaluate the effectiveness of different management approaches for IPA.
Main Methods:
- Retrospective review of 113 IPA cases (2015-2024).
- Analysis of patient demographics, clinical presentation, imaging, treatment, and outcomes.
- Inclusion of 100 patients in the final analysis.
Main Results:
- Common symptoms include back/flank pain (86%), abdominal pain (45%), and lower extremity discomfort (35%).
- Staphylococcus aureus (38%) and Escherichia coli (31%) were prevalent pathogens.
- Antibiotics alone succeeded in 76% of eligible patients; CT-guided percutaneous drainage (PCD) had a 44% success rate, with 39% requiring subsequent surgery. Overall mortality was 5%.
Conclusions:
- First-line treatment for IPA involves antibiotics and CT-guided percutaneous drainage (PCD).
- Surgical intervention is reserved for complex cases, including gas formation, neurological involvement, spinal proximity, or treatment failure.
- The observed mortality rate of 5% is lower than previously reported.
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