Case ReportPsoas Abscess

Husam MaqboulHasan Arafat

Chief Complaint

• A 69-year-old lady, was referred to our hospital complaining of right flank pain radiating to the groin• The pain was associated with fever (38.4 orally, measured at onset• The pain was also associated with nausea without vomiting and

general fatigue, however, her fatigability did not keep her from attending her daughters wedding• Pain was exacerbated by extending the hip• The patient reported that her symptoms started as fever and cough

10 days ago, flank pain started in the 5th day

Past Medical History

• The patient underwent cholecystectomy in 2006 in Qalqilya UNRWA hospital• She claimed that her gallbladder was still inflamed when the surgeon

started the procedure• Post-op, the patient became feverish and jaundiced, she was referred

to Augusta Victoria hospital-Jerusalem, where a T-drain was inserted to relieve her jaundice• The patient did not improve, so she was referred to Hadassah

Medical Centre, where she underwent a repair procedure, the operation was successful• The patient was diagnosed with bile peritonitis caused by bile leak

O/E

• The patient was lying on her left side in the bed• She looked tired and uncomfortable, she was alert• Her right hip was flexed• She had a drain the posterior side of her right flank with frank

greenish pus in the urine bag• The abdomen was distended with no tenderness

Imaging

• As you can see on the CT, the patient right psoas muscle is distended by a low-attenuation lesion,the lesion represents the abscess

Treatment

• CT-guided percutaneous drainage: draining the abscess through the skin under CT, the procedure was successful

POD 1

• Heart rate: 96• Blood pressure: 145/79• Temperature: 36.9 orally• O2 SAT: 95• Drain: 900 mL pus

Psoas Abscess

• A.K.A retroperitoneal abscess• At the beginning of the 20th century, TB (Pott’s disease) was the most

common cause• Nowadays, it is mostly secondary to direct spread of infection from

an inflamed digestive/urinary tract• Perforation might/might not be present

Psoas Abscess

• In recent years, a primary psoas abscess originating from an occult source via hematogenous spread became more common• This usually presents in the immunocompromised, elderly and IV

drug abusers

Psoas Abscess

• Presentation is usually vague, consisting of back pain, fever and fatigue (non-specific symptoms)• A swelling might be felt at the groin, it might simulate femoral hernia

My group after finishing our first rotation, it was OB/GYN. We took this photo in Tulkarem, 2 days before Eid Al-Adha (read about it). I am the dude at the far right (your right)