Iliopsoas Abscess as the First Clinical Manifestation of Crohn’s Disease - A Rare Case Report and Literature Review

Abstract

Objective: Iliopsoas abscess is a rare complication of fistulizing Crohn’s disease, which is difficult to diagnose and manage. We report this case to alert clinicians to the diagnosis and management of this unusual association. Case presentation: A 31-year-old male who presented with right groin pain, and hip pain due to an iliopsoas abscess. He was found to have iliopsoas fistula and underlying Crohn’s disease. The right iliopsoas abscess was managed with CT guided percutaneous drainage and pigtail catheter placement and intravenous antibiotics. The patient was started on mesalamine and prednisone. A month later, the patient became symptomatic again and a duodenocolic fistula was found. A laparoscopic extended right hemicolectomy with both fistulas takes-down, end ileostomy and mucus fistula were performed. Pathology revealed chronic active Crohn’s ileocolitis. His ileostomy was reversed three months later. The patient recovered uneventfully and was doing well after six-month follow-up. Conclusions: Iliopsoas abscess can be a rare presentation of Crohn’s disease. Evaluation with CT imaging, and initial management with drainage and antibiotics are recommended. Surgical intervention should be considered early for impending arthritis.