PSOAS MUSCLE ABSCESS FOLLOWING CESAREAN SECTION: A CASE REPORT

Psoas muscle abscess is a rare but potentially life-threatening condition and is exceptionally uncommon after cesarean section. Its nonspecific clinical presentation may delay diagnosis.

A 37-year-old multiparous woman (gravida 4, para 2, with two previous spontaneous abortions) at 34 weeks of gestation underwent emergency repeat cesarean section for pathological cardiotocography, uterine hypertonia, threatened fetal asphyxia, and previous cesarean section. The pregnancy was complicated by pregnancy-induced hypertension. The cesarean section was uncomplicated, and no perioperative antibiotic prophylaxis was administered. On postoperative day 9, she developed fever, lower abdominal pain, right hip pain, and impaired ambulation. Partial wound dehiscence was noted and the wound swab grew Escherichia coli. Contrast-enhanced CT revealed a large complex right-sided intra-abdominal collection measuring approximately 12×10 cm with a hydroaeric level and peripheral enhancement, suspicious for abscess. Because of clinical deterioration and the size and complexity of the collection, relaparotomy and surgical drainage were performed. Urine culture also grew Escherichia coli, whereas blood cultures were sterile. Culture of the abscess material was not performed. Antimicrobial treatment consisted of cefazolin for 7 days, gentamicin for 5 days, followed by vancomycin, imipenem, and metronidazole for an additional 5 days. The patient improved clinically, inflammatory markers decreased, and subsequent ultrasound demonstrated resolution of the collection.

Psoas abscess should be considered in patients with persistent postpartum fever, particularly when accompanied by hip pain or impaired ambulation. Early imaging and appropriate source control are important for favorable maternal outcomes.