ABSCESS OF THE ILIOPSOAS MUSCLE ASSOCIATED EXTRENAL FISTULA OF THE RECTUM CAUSED BY RADIATION PROCTITIS-A CASE REPORT-

Abstract

This paper deals with a case of abscess of the iliopsoas muscle an intractable external fistula of the rectum caused by adiation proctitis. In a 68-year-old man. There were previous histories of undergoing an A-C bypass operetion for coronary stricture 10 years before; and undergoing aportial resection of the bladder with radiation therapy for urinary bladder cancer, flowed by colostomy for hemorrage and stricture of the rectumu for rdiation froctitis 2 year before admission. In April, 1997 when he had been treated at outpatient clinic, exudmation of pusfrom the sacurred that was diagnosed external fistula of the rectum on a fistulography and he was continuously treated on an ambulant basis. On november 17, 1997, the patient had a temprature 38.7°C, the while blood cell count increased to 35×104/ml, inflammation reactiom increased, and unconsiouzsness appeared. An emergency CT revealed retention of fluid in the retroperitoneum covering from the fistulation through the iliopsoas musucle to peivis. An abscess of the ileopsoas muscle was diagnosed. It was detrmined that any operations under general anesthesiawere impossible due to poor general condition, and an emergency incision drainage was perfomed under local anesthesia. There after, the patient developed MRSA septicemia which demanded redrainage and stric general management, but he was successfully freed from the management. Although the intractable fistula in persistently present, he was discharged after a resection of sequestrum and is followed on an ambulant basis.