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Obturator internus pyomyositis. A case report

D Birkbeck1, J T Watson

  • 1Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, MI 48202, USA.

Clinical Orthopaedics and Related Research
|July 1, 1995
PubMed
Summary
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This case report details the first instance of spontaneous bacterial pyomyositis in the obturator internus muscle. Early diagnosis and surgical planning were aided by advanced imaging techniques for this deep pelvic infection.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Radiology

Background:

  • Pyomyositis, a bacterial muscle infection, is increasingly reported in temperate regions.
  • Deep pelvic infections pose significant morbidity and mortality risks, potentially spreading to adjacent structures.
  • Orthopedic surgeons play a crucial role in managing pyomyositis cases.

Observation:

  • This study presents the first reported case of spontaneous bacterial pyomyositis affecting the obturator internus muscle.
  • The deep pelvic location of the infection necessitated advanced imaging modalities for diagnosis and surgical planning.
  • Diagnostic imaging included ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI).

Findings:

  • Advanced imaging (ultrasound, CT, MRI) was integral for surgical planning and diagnosis of the deep pelvic obturator internus pyomyositis.

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  • While Staphylococcus aureus is the most common cause (95%), negative cultures can occur.
  • Disseminated Neisseria gonorrhoeae should be considered in sexually active individuals, requiring specific culture methods (Thayer-Martin agar).

    • Implications:

    • This case highlights the importance of considering less common pathogens and utilizing comprehensive imaging for deep pelvic pyomyositis.
    • Accurate diagnosis and surgical planning are critical for managing this potentially life-threatening condition.
    • Awareness of alternative causative agents like Neisseria gonorrhoeae can improve patient outcomes through targeted treatment.