Primary vs secondary iliopsoas abscess. Presentation, microbiology, and treatment
R. O. Santaella, E. K. Fishman and P. A. Lipsett
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md, USA.
OBJECTIVE: To review the characteristics of patient presentation,
microbiology, and treatment of primary iliopsoas abscess. DESIGN: A case
series of patients with iliopsoas abscess diagnosed on computed tomographic
scans from 1987 to 1994. SETTING: Tertiary care inner-city university
hospital. PATIENTS: Eleven patients with secondary iliopsoas abscess,
defined as being secondary to gastrointestinal or genitourinary causes or
trauma, and seven patients with primary abscess, defined as the absence of
the above causes. MAIN OUTCOME MEASURES: Patient characteristics,
presenting symptoms and signs, microbiologic characteristics, treatment,
and clinical course of patients with primary iliopsoas abscesses compared
with those in patients with secondary abscesses. RESULTS: In the primary
group, six patients (86%) were intravenous drug users and four (57%) were
positive for human immunodeficiency virus. Staphylococcus aureus grew from
cultures from five of seven patients with primary abscesses, whereas
secondary abscesses had enteric flora. The typical patient presentation
included fever, with complaints of pain in the flank, hip, or abdomen.
Comparison of abscess drainage options showed shorter hospitalizations for
surgical drainage than for percutaneous drainage (15.9 vs 28.5 days; P <
or = .01). CONCLUSIONS: A patient who presents with pain in the flank, hip,
or abdomen may have a primary iliopsoas abscess. Computed tomography is the
standard method of diagnosis. Antibiotic regimens for patients with primary
iliopsoas abscess should include coverage for S aureus, and patients with
secondary abscesses should have antibiotic regimens tailored for enteric
bacteria. Drainage of abscess is essential for appropriate treatment, and
surgical drainage is superior to percutaneous drainage in achieving prompt
recovery.
