Psoas Muscle Abscess-Diagnosis and Approaches of Treatment

Abstract

Psoas muscle abscess is rare and presents a diagnostic challenge requiring a high index of suspicion. The relative obscurity of this entity, coupled with a typically insidious presentation, frequently result in diagnostic delays, attempts at conservative treatment, increased morbidity and prolong or recurrent hospitalization. Classic symptoms include fever, flank pain, abdominal pain, hip flexion contracture, sciatica and limp. Other symptoms include weight loss, abdominal mass, nausea, vomiting, diarrhea, limb mass, limb pain and chills. There were six cases of psoas muscle abscess with various degree of sepsis from January 1999 to June 2000. There was no significant risk factor to induce psoas muscle abscess except old age. The conservative and supportive treatment may stabilize the vital signs but surgical intervention and drainage must be done to treat the patients with psoas muscle abscess. The drainage procedures could be achieved via CT-guided drainage or surgical intervention. There are several methods to approach the psoas muscle, including anterior extraperitoneal, trans-abdominal, thigh and back incision. We preferred transverse back incision via the lumbar triangle to approach the psoas muscle and combined with groin incision if the erythema at the thigh is marked. Effective drainage and proper antibiotics are still the gold standard to treat the abscess resulted in the infectious diseases.