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Management and treatment of iliopsoas abscess.

Archives of Surgery 2009 October
HYPOTHESIS: Even with improved diagnostic modalities, the optimum management strategy for iliopsoas abscess (IPA) is not uniform, and a better understanding of treatment options is needed.

DESIGN: Retrospective case series.

SETTING: Academic center.

PATIENTS: Sixty-one consecutive patients diagnosed as having IPA at the Mount Sinai Medical Center, New York, New York, from August 1, 2000, to December 30, 2007.

MAIN OUTCOME MEASURES: Development and cause of IPA, the need for additional interventions, morbidity, and mortality.

RESULTS: The mean age of the patients was 53 years. Most patients were initially seen with pain (95% [58 of 61]), gastrointestinal tract complaints (43% [26 of 61]), and lower extremity pain (30% [18 of 61]). Primary and secondary abscesses occurred in 11% (7 of 61) and 89% (54 of 61), respectively. The most frequent underlying cause of secondary abscesses was inflammatory bowel disease. Broad-spectrum antibiotics were prescribed in all patients. Computed tomography was the most common diagnostic modality used. Abscesses were larger than 6 cm in 39% of patients (24 of 61), bilateral in 13% (8 of 61), and multiple in 25% (15 of 61). Nine patients were treated using antibiotics alone, with a success rate of 78% (7 of 9). Forty-eight patients initially underwent percutaneous drainage, which was successful in 40% (19 of 48). Among those with unresolved IPAs, 71% of patients ultimately required surgery, and the IPAs were typically associated with underlying gastrointestinal tract causes. Seven percent (4 of 61) of patients directly underwent exploratory surgery and drainage, and all of these interventions were successful. The overall mortality was 5% (3 of 61).

CONCLUSIONS: Iliopsoas abscess remains a therapeutic challenge. Gastrointestinal tract disease is the most common cause, with computed tomography as the diagnostic modality of choice. Percutaneous drainage remains the initial treatment modality but is rarely the sole therapy required. Patients with inflammatory bowel disease are likely to require ultimate operative management.

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