Huang J J, Ruaan M K, Lan R R, Wang M C
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, ROC.
J Infect. 2000 May;40(3):248-55. doi: 10.1053/jinf.2000.0643.
To study the variations of aetiology in the patients with acute pyogenic iliopsoas abscess and identify the appropriate diagnostic modalities as well as therapeutic alternatives (e.g. extraperitoneal or retrofascial percutaneous catheter drainage, PCD) other than surgery.
We carried out a retrospective review and analysis of 25 patients with acute pyogenic iliopsoas abscess in our institution from August 1988 to July 1998. Blood and urine cultures, imaging studies of the plain films of the abdomen (KUB), ultrasonography (echo) and computed tomography (CT scan) were performed in all patients. The therapeutic regimens included antibiotics only, PCD or aspiration, and surgery.
The male to female ratio was 7: 18. The mean age was 64 years old. Diabetes mellitus (64%) was the dominant predisposing or associated factor. The most common aetiological source was urinary tract infection (52%) with enteric micro-organisms (Escherichia coli: 44% and Klebsiella spp.: 24%). Nineteen patients (76%) had pain in the abdomen, flank or back. Six cases (24%) were classified as 'primary' abscess, and only two patients survived. Nine cases were treated with antibiotics alone, only four responded and the others expired. Of the 15 cases receiving PCD or aspiration, five cases received subsequent surgical drainage or nephrectomy and survived. Another one case of Clostridia gas gangrene received emergency fasciotomy and expired. The total mortality was extremely high (11/25, 44%).
We concluded that: (i) the aetiology of iliopsoas abscess may vary with the country of origin, with a preponderance of urinary tract infection in our Taiwanese series; (ii) a high index of suspicion is mandatory to enable early diagnosis of acute pyogenic iliopsoas abscess, particularly for older diabetic patients with fever, pain in the abdomen or flank, limp or flexion of the ipsilateral hip; (iii) CT scan can confirm the diagnosis and define the extent of the abscess; (iv) effective management should include appropriate antibiotic therapy and drainage of the abscess; (v) image-guided PCD should be tried first because of its low morbidity. However, should it fail, subsequent surgical drainage should be performed.
研究急性化脓性髂腰肌脓肿患者的病因变化，并确定除手术外合适的诊断方法以及治疗方案（如腹膜外或筋膜后经皮导管引流，PCD）。
我们对1988年8月至1998年7月在我院收治的25例急性化脓性髂腰肌脓肿患者进行了回顾性分析。所有患者均进行了血培养、尿培养、腹部平片（KUB）、超声检查（超声）和计算机断层扫描（CT扫描）。治疗方案包括单纯抗生素治疗、PCD或穿刺抽吸以及手术治疗。
男女比例为7:18。平均年龄为64岁。糖尿病（64%）是主要的易感或相关因素。最常见的病因是尿路感染（52%），病原菌为肠道微生物（大肠杆菌：44%，克雷伯菌属：24%）。19例（76%）患者有腹部、侧腹或背部疼痛。6例（24%）被归类为“原发性”脓肿，仅2例存活。9例患者仅接受抗生素治疗，仅4例有反应，其余患者死亡。15例接受PCD或穿刺抽吸的患者中，5例随后接受了手术引流或肾切除术并存活。另1例梭状芽孢杆菌气性坏疽患者接受了急诊筋膜切开术，最终死亡。总死亡率极高（11/25，44%）。
我们得出以下结论：（i）髂腰肌脓肿的病因可能因国家不同而有所差异，在我们的台湾系列病例中尿路感染占优势；（ii）对于急性化脓性髂腰肌脓肿，必须保持高度怀疑指数以便早期诊断，特别是对于有发热、腹部或侧腹疼痛、同侧髋关节跛行或屈曲的老年糖尿病患者；（iii）CT扫描可以确诊并明确脓肿范围；（iv）有效的治疗应包括适当的抗生素治疗和脓肿引流；（v）由于其低发病率，应首先尝试影像引导下的PCD。然而，如果失败，应进行后续的手术引流。
