Groin Injury in a Collegiate Football Athlete

Abstract

HISTORY: A 19-year-old Division 1 Collegiate football player presented to the Emergency Department four days following injury to his right groin during football practice. He complained of severe right groin pain accompanied by fatigue, fevers, nausea, and diarrhea. He was admitted to the hospital for pain control and MRI evaluation of psoas injury. On hospital day 1 he developed oliguria with acute kidney injury and rhabdomyolysis. Within hours he became febrile, tachypnic, and tachycardic and was transferred to the medical intensive care unit for sepsis and acute kidney injury. PHYSICAL EXAMINATION: T 101.3, HR 134, RR 40, BP 105/53 Ill-appearing male in moderate respiratory distress. Cardiovascular: Tachycardic with regular rhythm, new systolic murmur, grade 2/6 at the left upper sternal border, distal pulses 2+ and equal bilaterally. Respiratory: Tachypneic, clear to auscultation bilaterally. Abdomen: soft, tender to palpation right lower quadrant, no guarding or rebound. Extremities: No obvious deformities, significant pain with extension of right hip and knee. Skin: flushed. Neuro: alert and oriented to person, place, and time. DIFFERENTIAL DIAGNOSIS: Right psoas abscess Pyomyositis Appendicitis TEST AND RESULTS: Laboratory studies: Creatinine2.8 CPK1530 Procalcitonin57 Lactic acid3.1 CT Abd/Pelvis: Right iliopsoas muscle injury Possible acute avulsion fracture Soft tissue stranding suggestive of possible superinfection Normal appendix MRI: 14.2 x 5.7 x 5.3 cm abscess located in the right iliopsoas and distal myotendinous junction FINAL WORKING DIAGNOSIS: Myonecrosis of the right iliopsoas TREATMENT AND OUTCOMES: 1. Anterior thigh incision and debridement of necrotic right iliopsoas muscle with delayed primary closure 2. Targeted antibiotic therapy 3. Rehabilitation started 6 weeks post-injury 4. Returned to sport without limitation four months post-injury