PRIMARY PYOGENIC ABSCESS OF THE PSOAS MUS CLE - REPORT OF 5 CASES

The authors discuss the diagnostic and therapeutic aspects of primary pyogenic abscess of the psoas muscle based on a series of 5 cases. Fiv e patients between the ages of 15 and 64 years (mean: 38.2 years) were admitted to the urology department between January 1994 and December 1996 with fever, abdominal pain and low back pain, and psoitis in 1 ca se. The mean delay to consultation was 42 days, Clinical examination r evealed a painful mass in the lumbar region and flank in 5 cases, Leuk ocytosis was detected in 5 patients. Radiological examination demonstr ated loss of the lateral border of the psoas in 4 cases. Ultrasonograp hy showed an enlarged psoas muscle in every case with a hypoechoic mas s in 2 cases and a heterogeneous mass in the other 3 cases. Computed t omography, performed in 2 patients, confirmed the ultrasound findings in 1 case and excluded the diagnosis of type IV hydatid cyst of the ps oas muscle in the other patient. The abscess was evacuated by percutan eous drain in 1 patient requiring a second percutaneous drainage for r econstitution of the abscess. Surgical drainage was performed immediat ely in 3 patients and after failure of antibiotic treatment in I patie nt. The hospital stay did not exceed 7 days after surgical drainage, b ut was 25 days after the first percutaneous drainage and 20 days after the second percutaneous drainage. The authors emphasize the multiple advantages and efficacy of surgical drainage of psoas abscess.