Psoas Abscess as a Complication of Crohn`s Disease - a Case Report

Abstract

Introduction: Crohn`s disease is a chronic inflammatory bowel disease well-known for its serious complications and variable prognosis. We hereby present a recent clinical case as an example of such one. Materials and Methods: A 27-year-old Caucasian man with a short previous history of Crohn`s ileocolitis presented with right lower abdominal and hip pain radiating to the knee joint, inability to extend both hip and knee joints and limping as a consequence of these symptoms. The immediately performed magnetic resonance imaging showed that the patient has a right retroperitoneal psoas abscess, adjacent to the pathologically changed parts of the ileum, caecum and colon, later confirmed by computed tomography and ultrasound of the abdomen and the pelvis. Results: Following the administration of combination of antibiotics and CT-guided percutaneous drainage of the abscess with a pigtail catheter, the patient`s symptoms significantly improved. Other than that, all possible causes for this complication in the differential diagnosis were excluded. As his general condition was stable and gradually improving, surgical resection was not seen as necessary. The patient seemed eligible for initiation of biotherapy with infliximab in addition to the continuous treatment with mesalazine and Enterol. Conclusion: We aim to emphasize that the cause for such serious condition as a retroperitoneal abscess of the psoas muscle nowadays is most likely to be associated with a chronic inflammatory disease of the nearest structures as in Crohn`s disease. It should be among the first diagnoses to be excluded by thorough history and examination, laboratory tests, imaging and multiple biopsies. If confirmed, the complication should be treated with caution and complete collaboration between gastroenterology, radiology and general surgery specialists. Also, conservative treatment appears to be useful not only for induction, but also for avoiding surgical approach.