The Clinical Analysis of Iliopsoas Muscle Abscess

• Main Authors: Sung-Yuan Hu, 胡松原
• Other Authors: Ming-Chin Chou
• Format: Others
• Language: zh-TW
• Published: 2003
• Online Access: http://ndltd.ncl.edu.tw/handle/84777773131301811806

碩士 === 中山醫學大學 === 醫學研究所 === 91 === Abstract Subject: We reviewed the serial cases of the iliopsoas muscle abscess (IPA) and discuss the management and prognosis of the IPA during the last 6 years at the emergency department of Veterans General Hospital in Taichung. Patients and methods: According the ICD No. (728.9), there were 51 patients diagnosed to have the IPA by clinical manifestations, laboratory studies and imaging survey during the last 6 years (from June, 1996 to June, 2002). Results: There were 51 patients enrolled in our analysis by clinical manifestations, laboratory studies and imaging survey. 30 patients (58.8%) were male and 21 patients (41.2%) were female. The age ranged from 35 to 87 (62.9+/-12.7) years. The admission length of stay was from 1 to 79 (25.9+/-17.1) days. The most common chief complaint was pain or weakness of lower limbs found in 38 patients (74.5%). The clinical classic triad of IPA, pain, lower limb weakness and/or deformity combined with fever of unknown origin, was found in 16 patients (31.4%). Laboratory data revealed leukocytosis (70.6%) with left shift (75.0%) and bandemia (11.8%), anemia (66.7%), increased blood urea nitrogen (BUN) (34.8%), increased creatinine (Cr) (30.0%) and elevated alkaline phosphatase (62.5%). The most common microorganisms in pus tissue cultures were Gram-positive cocci found in 14 patients (50.0%) of 28 patients with positive findings of pus/tissue cultures. The Gram-positive coccus included 9 patients (32.1%) with the infection of Staphylococcus. The second most common microorganisms were Gram-negative bacilli found in 11 patients (39.3%) of 28 patients with positive findings of pus tissue cultures. The positive rate of blood culture was 50%, found in 20 of 40 patients who had blood cultures. 37 patients (72.5%) received management via surgical intervention by laparotomy and/or PCD under US-/CT-guidance, plus the treatment with intravenous antibiotics, according to the culture data of blood and/or pus tissue. The remaining 14 patients (27.5%) received conservative medical treatment with intravenous antibiotics only, according to the culture data of blood and/or pus tissue. There were 45 patients (88.2%) who survived after treatment and 6 patients (11.8%) expired. The mortality rate in the group of medical treatment (21.4%) was significant higher than that in the group of surgical intervention (8.1%). Conclusion: Our report revealed that there were only 31.4% demonstrating the clinical triad of IPA, including fever, limping and pain, similar to previous reports of 30%~50%. The most common microorganism of pus/tissue culture was Gram-positive coccus (50.0%), and Staphylococcus is the leading microorganism (32.1%), which is lower than previous reports of 44.4%~95%. The positive rate of blood culture was 50%, found in 20 of 40 patients receiving blood cultures, which is higher than previous reports of 42%. The management included surgical debridement, US-/CT-guidance PCD, plus intravenous antibiotics, or conservative medical treatment with intravenous antibiotics only. The survival rate was 88.2% and 6 patients (11.8%) expired. The mortality rate was similar to previous reports of 2.5~25%. We find that old age, anemia, high BUN and Cr were poor prognostic factors for the IPA and the mortality rate is higher in the conservative group in this study. Suggestion: In a patient with a suspected IPA who reveals abnormal content on the iliopsoas muscle imaging, abscess should be considered. Early diagnosis and prompt aggressive treatment for reducing the mortality rate should be informative, especially for the primary care physician in the emergency department. According to the chief complaint, past history, underlying disease, physical examination, laboratory data, imaging survey and the result of bacterial culture, we build up the clinical pathway of diagnosis, management and follow-up for the IPA. Key words: abscess, diagnosis, iliopsoas muscle, management, prognosis