Iliopsoas abscesses: Diagnostic, aetiologic and therapeutic approach in five patients with a literature review

Objective. Iliopsoas abscess is a relatively rare disease. Many cases present atypical clinical characteristics. Iliopsoas abscess can be primary or secondary to gastrointestinal and genitourinary infections and in developed countries most of these abscesses are of non-tuberculous aetiology. A high index of clinical suspicion, the past and recent history of the patient and imaging studies can be helpful in diagnosing the disease. Early treatment with drainage, surgery or appropriate antibiotic therapy is necessary before the sepsis becomes lethal. The purpose of the study was to present five cases with iliopsoas abscesses based on the rarity of this clinical entity. Material and methods. Five cases with iliopsoas abscess, treated during the past 10 years were analysed retrospectively, with emphasis on the diagnostic and therapeutic approach to the disease. Results. Three out of five cases were primary abscesses; one was of tuberculous aetiology and one secondary to bowel perforation due to a tumour. Staphylococcus aureus was the main bacterium in primary abscesses. Percutaneous drainage with administration of appropriate antibiotics was the main treatment. The secondary psoas abscess was treated successfully with surgery. Owing to long-standing septic and atypical symptoms before admission, one case had a lethal course, despite the early hospital diagnosis and treatment. Conclusions. The aetiology of iliopsoas abscess can vary, disposing to a high index of suspicion. Imaging studies can confirm the diagnosis early, and differentiation between primary and secondary type determines the most appropriate kind of treatment.