Management and Treatment of Iliopsoas Abscess for period 10 years, January 2003-January 2013

Abstract

Aim of Study: Even with improved diagnostic modalities, the optimum management strategy for iliopsoas abscess (IPA) is not uniform, and a better understanding of treatment options is needed. Development and cause of IPA, the need for additional interventions, morbidity, and mortality. Materials and Methods: Forty-one consecutive patients diagnosed as having IPA at the University Hospital “Shefqet Ndroqi”Tirana Albania, from January 2003-January 2013. Results: The mean age of the patients was 56 years (range 13-78 years). Most patients were initially seen with pain (78% [32 of 41]), gastrointestinal tract complaints (39% [16 of 41]), and lower extremity pain (26.8% [11 of 41]). Primary and secondary abscesses occurred in 17% (7 of 41) and 83% (34 of 41), respectively. The most frequent underlying cause of secondary abscesses was inflammatory bowel disease. Broad-spectrum antibiotics were prescribed in all patients. Computed tomography was the most common diagnostic modality used. Abscesses were larger than 6 cm in 68% of patients (28 of 41), bilateral in 7% (3 of 41), and multiple in 12% (5 of 41). Three patients were treated using antibiotics and antibacils alone, with a success rate of 66% (2 of 3). Thirty-eight patients initially underwent percutaneous drainage, which was successful in 42% (16 of 38). Among those with unresolved IPAs,Twenty-three 60 % of patients ultimately required surgery, and the IPAs were typically associated with underlying gastrointestinal tract causes. It can also be of tuberculous etiology and associated with cold abscesses of lower thoracic and upper lumbar vertebral bodies, as the psoas is attached to these vertebrae in 70% (15 of 41) of patients. Seven percent (3 of 41) of patients directly underwent exploratory surgery and drainage, and all of these interventions were successful. It can also be of tuberculous etiology and associated with cold abscesses of lower thoracic and upper lumbar vertebral bodies, as the psoas is attached to these vertebrae in 36% (15 of 41) of patients. The overall mortality was 1% (1 of 41), morbidity in 3 patients were osteomyelitis and chronic fistula musculocutane, intestinal fistulae in 1 patient, pleural empyema in two patiens that needed toracothomy ,pleurectomy, decorticim and pleural tube, also lower extremity paresis in 2 patients. Conclusions: Iliopsoas abscess remains a therapeutic challenge. Gastrointestinal tract disease is the most common cause, with computed tomography or MRI as the diagnostic modality of choice. Percutaneous drainage remains the initial treatment modality but is rarely the sole therapy required. Patients with inflammatory bowel disease and tuberculous etiology and associated with cold abscesses of lower thoracic and upper lumbar vertebral bodies are likely to require ultimate operative management. Keywords: Iliopsoas abscess, Iliac et psoas muscle (iliopsoass), Percutaneous Drainage, morbus Pott.