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Published on: September 21, 2015
Rectal drainage: unusual evolution of a psoas abscess
V Ibañez1, C Gutierrez, J E Barrios
1Department of Pediatric Surgery, La Fe Children's Hospital, Valencia, Spain.
Insights
Two pediatric cases of primary psoas abscess were treated successfully with open drainage and antibiotics. This rare condition requires prompt intervention for favorable outcomes in children.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Urology
Background:
- Primary psoas abscess is a rare bacterial infection of the psoas muscle, particularly uncommon in pediatric patients.
- Early diagnosis and management are crucial to prevent complications such as sepsis and musculoskeletal damage.
Observation:
- Two pediatric patients, aged 15 months and 4 years, presented with primary psoas abscess.
- The second patient developed significant ureterohydronephrosis and spontaneous rectal drainage, highlighting the potential severity and natural course of the condition.
- Despite spontaneous drainage, complete resolution was not achieved, necessitating surgical intervention.
Findings:
- Both patients underwent open drainage and received systemic antibiotics, leading to a good clinical response.
- Patients were discharged on postoperative days 7 and 12, with no complications reported at a 5-month follow-up.
- This suggests that prompt surgical drainage combined with antibiotics is an effective treatment strategy.
Implications:
- This case series underscores the importance of considering primary psoas abscess in the differential diagnosis of pediatric abdominal pain and fever.
- Effective management involves timely surgical intervention and appropriate antibiotic therapy.
- Further research into the etiological factors and optimal treatment protocols for pediatric primary psoas abscess is warranted.
Abstract:
We report two cases of primary psoas abscess in two patients of 15 months and 4 years of age. As the first case showed the natural history of this process the second one was large enough to produce a huge ureterohydronephrosis and to drain through the rectal wall to the rectum spontaneously, although this natural way did not achieve complete drainage. Both were treated by open drainage and systemic antibiotics with good response. They were discharged at the 7th and 12th postoperative day. 5 months later no complication has come up. Etiological, clinical and therapeutic aspects of this unusual pathology are reviewed.
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