Acute pyogenic iliopsoas abscess in Taiwan: Clinical features, diagnosis, treatments and outcome

Objectives: To study the variations of aetiology in the patients with acute pyogenic iliopsoas abscess and identify the appropriate diagnostic modalit ies as well as therapeutic alternatives (e.g, extraperitoneal or retrofasci al percutaneous catheter drainage, PCD) other than surgery Methods: We carried out a retrospective review and analysis of 25 patients with acute Pyogenic iliopsoas abscess in our institution from August 1988 t o July 1998. Blood and urine cultures, imaging studies of the plain films o f the abdomen (KUB), ultrasonography (echo) and computed tomography (CT sca n) were performed in all patients, The therapeutic regimens included antibi otics only PCD or aspiration, and surgery: Results: The male to female ratio was 7: 18, The mean age was 64 years old. Diabetes mellitus (64%) was the dominant predisposing or associated factor . The most common aetiological source was urinary tract infection (52%) wit h enteric micro-organisms (Escherichia coli: 44 % and Klebsiella spp.: 24%) . Nineteen patients (76%) had pain in the abdomen, flank or back. Sir cases (24%) were classified as 'primary' abscess, and only. two patients survive d. Nine eases were treated with antibiotics alone, only four responded and the others expired. Of the 15 cases receiving PCD or aspiration five cases received subsequent surgical drainage or nephrectomy and sun hpd. Another o ne ease of Clostridia gas gangrene received emergency fasciotomy and expire d, The total mortality was extremely high (11/25, 44%). Conclusions: We concluded that: (i) the aetiology of iliopsoas abscess may vary with the country of origin, nith a preponderance of urinary tract infe ction in our Taiwanese series; (ii) a high index of suspicion is mandatory to enable early diagnosis of acute pyogenic iliopsoas abscess, particularly for older diabetic patients with fever pain in the abdomen or flank, limp or flexion of the ipsilateral hip: (iii) CT scan can confirm the diagnosis and define the extent of the abscess; (iv) effective management should incl ude appropriate antibiotic therapy and drainage of the abscess; (v) image-g uided PCD should be tried first because of its lo rv morbidity: However , s hould it fail, subsequent surgical drainage should be performed.