Iliopsoas Abscess: A Narrative Review

Area of Science:

• Infectious Diseases
• Radiology
• Surgical Infections

Background:

• Iliopsoas abscess (IPA) is a rare, life-threatening retroperitoneal infection often diagnosed late due to nonspecific symptoms.
• The classic diagnostic triad is present in only 30% of patients, leading to delayed treatment and increased morbidity/mortality.
• Microbial etiology varies geographically, and IPA can be primary or secondary to other infections.

Purpose of the Study:

• To review the current knowledge on iliopsoas abscess (IPA).
• To emphasize the importance of early recognition and precise diagnosis of IPA.
• To reduce diagnostic and treatment delays for IPA using modern imaging techniques.

Main Methods:

• A comprehensive literature search was conducted from 1980 to December 2024, including case reports, series, reviews, and observational studies.
• Keywords used were "iliopsoas abscess," "retroperitoneal infection," "psoas muscle disorder," "pyogenic psoas abscess," and "psoas abscess."
• A total of 247 papers published in English were reviewed, with inclusion criteria encompassing original and review articles.

Main Results:

• Diagnosis of IPA has improved with modern imaging (ultrasound, CT, MRI).
• However, the sequential use of these imaging modalities is not standardized.
• There is currently no uniform treatment protocol for IPA.

Conclusions:

• Despite improved diagnostic capabilities, challenges in IPA management persist.
• Current management involves broad-spectrum antibiotics and drainage (percutaneous or surgical).
• Further standardization in diagnostic and treatment approaches is needed for optimal patient outcomes.