Etiological factors of psoas abscesses

Öz

Objective: Psoas abscess (PA) is a rare infection disease, which is difficult to diagnose. In the present study, we aimed to evaluate etiological factors and treatment results of patients with PA. Methods: Files of 20 patients who were diagnosed as PA between December 2006 and January 2013, were retrospectively analyzed. Patient\'s whose data were entirely reached and diagnosed by Ultrasonography and/or Computed Tomography as an exact PA were included to the study. Results: The mean age of the 20 patients was 48.8 (range 17-82) year, and 6 of them were female and remaining were male. Psoas abscess were on the right side in 12 patients (60%), on the left side in seven patients (35%), and bilateral in one (5%). According to data records four patients had Diabetes Mellitus (20%), two had Hypertension (10%), one had cerebrovascular disease (5%), one had tuberculosis (5%), one had hyperthyroidism (5%), one had mental retardation (5%), and one had paraplegia (5%). Six case (30%) were diagnosed as a primary psoas abscess (pPA, sPA) and remaining (n=14, %70) were diagnosed as secondary. Percutaneous drainage was performed to 13 patients (65%) and exploration was performed to three patients (15%) as a treatment modality. Remaining four patients (20%) were followed by medical treatment. Conclusion: Psoas abscess is rare and have variable and non-specific clinical characteristic, which may lead to difficulty in diagnosis. In developed and developing countries, it has been reported that the most common causes of sPA are Pott's disease, and Crohn's disease, also it should be taken into account that open surgery and urinary tract stone disease can receive a significant portion of the etiological factors. J Clin Exp Invest 2014; 5 (1): 59-63

Anahtar Kelimeler

• Psoas abscess, etiological factors, primary psoas abscess, secondary psoas abscess.

Psoas apselerinde etyolojik faktörler

Öz

Amaç: Psoas apsesi (PA) nadir görülen, zor tanı konulabilen bir enfeksiyon hastalığıdır. Bu çalışmada PA tanısı olan hastaları etyolojik faktörler ve tedavi sonuçları açısından değerlendirmeyi amaçladık. Yöntemler: Aralık 2006-Ocak 2013 tarihleri arasında PA tanısı konulan 20 hastanın dosyaları geriye dönük olarak tarandı. Çalışmaya ultrasonografi ve/veya bilgisayarlı tomografi ile kesin PA tanısı konulan ve tüm verilerine ulaşılan hastalar dahil edildi. Bulgular: Çalışmaya alınan 20 hastanın yaş ortalaması: 48,8 (17-82) yıl, 6’sı kadın, 14’ü erkek idi. Hastaların 12’sinde (%60) sağ tarafta, 7’sinde (%35) sol tarafta ve 1’inde (%5) bilateral olarak PA görülmekteydi. Olguların 4’ünde (%20) diyabet, 2’sinde (%10) hipertansiyon, 1’inde (%5) serebrovasküler hastalık, 1’inde (%5) tüberküloz, 1’inde (%5) hipertroidi, 1’inde (%5) mental retardasyon, 1’inde (%5) parapleji olduğu kaydedildi. Olguların 6 tanesi primer (%30) ve 14 tanesi sekonder (%70) psoas apsesi (pPA, sPA) olarak değerlendirildi. 13 hastaya (%65) perkütan drenaj, 3 hastaya (%15) eksplorasyon yapıldı. Psoas apsesi olan 4 hastaya (%20) sadece medikal tedavi verildi. Sonuç: Psoas apsesinin nadir görülmesi, değişken ve özgün olmayan kliniği tanı koymada güçlüğe neden olabilmektedir. Gelişmiş ve gelişmekte olan ülkelerde sPA’inde en sık neden Pott hastalığı ve Chron hastalığı olarak bildirilmekle beraber açık cerrahi ve üriner sistem taş hastalığının da etyolojik faktörler arasında önemli bir yer alabildiği dikkate alınmalıdır.

Anahtar Kelimeler

• Psoas apsesi, etyolojik faktörler, primer psoas apsesi, sekonder psoas apsesi

Kaynakça

1. Ataus S, Alan C, Önder AU ve ark. Psoas abscess. Cerrahpaşa J Med 2000;31:89-93.
2. Mallick IH, Thoufeeq MH, Rajendran TP. Iliopsoas ab- scesses. Postgrad Med J 2004;80: 459-462.
3. Kandiş H, Çakır Z, Ilıca A.T ve ark. Acil Serviste Bir Psoas Apsesi Olgusu. Akademik Acil Tıp Dergisi 2008;7:38-40.
4. Malhotra R, Singh K.D, Bhan S. Primary pyogenic pso- as abscess of the psoas muscle. J Bone Joint Surg 1992;74;278-284.
5. Gruenwald I, Abrahamson J, Cohen O. Psoas abscess: case report and review of the literature. J Urol 1992; 147:1624-1626.
6. Goldberg B, Hedges JR, Stewart DW. Psoas abscees. J Emerg Med 1984;1:533-537.
7. Adelekan MO, Taiwo SS, Onile BA. A review of psoas abscess, Afr J Clin Exper Microbiol 2004;5:55-63.
8. Ricci MA, Rose FB, Meyer KK. Pyogenic psoas ab- scess: worldwide variations in etiology, World J Surg 1986;10:834-843.

9. Çubukçu S, Gürbüz U, Çevikkol C, et al. Primary psoas abscess presented with only low back pain, Turk J Phys Med Rehab 2006;52:137-140.
10. Procaccino JA, Lavery IC, Fazio VW, Oakley JR. Pso- as abscess: difficulties encountered, Dis Colon Rec- tum 1991;34:784-789.
11. Roy S. Cold abscess in caries spine. A prelimi- nary report, J Indian Med Assoc 1969;53:240-244. PMid:5359649
12. Atkinson C, Morris SK, Ng V, et al. A child with fever, hip pain and limp, CMAJ 2006;174:924.
13. Walsh TR, Reilly JR, Hanley E, et al. Changing etiol- ogy of iliopsoas abscess. Am J Surg 1992; 163: 413- 416.
14. Paley M, Sidhu PS, Evans RA, et al. Retroperitoneal collections etiology and radiological implications. Clin Radiol 1997;52:290-294.
15. Zissin R, Gayer G, Kots E, et al. Iliopsoas abscess: a report of 24 patients diagnosed by CT. Abdom Imag- ing 2001;26:533-539.
16. Bresee JS, Edwards BS, Edwards MS. Psoas ab- scess in children. Pediatr Infect Dis J 1990;9:201-206.
17. Buttaro M, González Della Vale A, Piccaluga F. Psoas abscess associated with infected total hiper-throplas- ty, J Arthroplasty 2002;17:230-234.
18. Lee BB, Kee WD, Griffth JF. Vertebral osteomyelitis and psoas abscess occurring after obstetric epidural anesthesia, Reg Anesth Pain Med 2002;27:220-224.
19. Chern CH, Hu SC, Kao WF, et al. Psoas abscess: making an early diagnosis in the ED. Am J Emerg Med 1997;15:83-88.
20. Turunç T, Turunç T, Demiroğlu Y.Z, Çolakoğlu Ş. Pso- as apsesi olan 15 hastanin retrospektif olarak değer- lendirilmesi. Mikrobiyoloji Bül 2009;43:121-125.
21. Vaz AP, Gomes J, Esteves J, et al. A rare cause of lower abdominal and pelvic mass, primary tubercu- lous abscess: a case report, Cases J 2009;2:182.
22. Santaella RO, Fishman EK, Lipsett PA. Primary and secondary iliopsoas abscess: presentation, microbiol- ogy, and treatment. Arch Surg 1995;130:1309-1313.
23. Desander AR, Cottone FJ, Evers ML. Iliopsoas ab- scess: etiology, diagnosis and treatment. Am Surg 1995;61:1087-1091.
24. Kadambari D, Jagdish S. Primary pygenic psoas ab- scess in children. Pediatr Surg Int 2000;46:408-410.
25. Dinc H, Onder C, Turhan AU et al. Percutaneus drain- age of tuberculous and nontuberculous psoas ab- scesses. Eur J Radiol 1996;23:1304.
26. Mueller PR, Ferrucci JT, Wittenberg J, et al. Iliopsoas abscess: treatment by CT guided catheter drainage. Am J Roentgenol 1984;142:359-362.
27. Gupta S, Suri S, Gulati M, et al. Iliopsoas abscess: percutaneous drainage under image guidance. Clin Radiol 1997;52:704-707.
28. Filho G.J.L, Matone J, Arasaki C.H, Kim S.B, Mansur N.S. Psoas abscess: diagnostic and therapeutic con- siderations in six patients. Int Surg 2000;85:339-343.
29. Kao PF,Tzen KY, Tsui Kh,et al. The specific gallium-67 scale uptake pattern in psoas abscesses. Eur J Nucl Med 1998 ;255:1442-1447.
30. Van den Berge M, De Marie S, Kuipers T, et al. Psoas abscess: report of a series and review of the literature. J Med 2005;63:413-416.