Melissas J, Romanos J, de Bree E, Schoretsanitis G, Askoxylakis J, Tsiftsis D D
Department of Surgical Oncology, Heraklion, University Hospital, Greece.
Acta Chir Belg. 2002 Apr;102(2):114-7. doi: 10.1080/00015458.2002.11679276.
Primary psoas abscesses are a rare clinical entity with subtle and non specific symptoms, most commonly seen in patients predisposed to infections. Early diagnosis and appropriate management are therefore challenging aspects for physicians.
We present three patients with primary pyogenic psoas abscess, treated at the Heraklion University Hospital, during a 5-year period. The two male and one female patient, aged 36-51 years were admitted with fever, abdominal pain and a palpable tender mass.
The classical sign of limping was absent in all cases. Positive psoas symptoms were detected in only two patients. CT scan accurately confirmed the diagnosis in all cases. The patients were successfully treated with antibiotics and prolonged surgical drainage. Staphylococcus aureus was the causative microorganism in the first two and Bacteroides fragilis in the third patient. This is the first reported case resulting from this specific bacteria. None of our patients had any predisposing risk factor.
A high index of suspicion is mandatory to enable early recognition of this rare clinical disease. CT scan is the standard diagnostic tool to confirm diagnosis. Prolonged drainage and appropriate antibiotics are essential for the successful treatment of primary psoas abscesses.
原发性腰大肌脓肿是一种临床罕见病，症状隐匿且不具有特异性，最常见于易发生感染的患者。因此，早期诊断和恰当治疗对医生而言是具有挑战性的方面。
我们呈现了5年间在伊拉克利翁大学医院接受治疗的3例原发性化脓性腰大肌脓肿患者。2例男性患者和1例女性患者，年龄在36至51岁之间，因发热、腹痛和可触及的压痛肿块入院。
所有病例均未出现典型的跛行体征。仅2例患者检测到阳性腰大肌症状。CT扫描在所有病例中均准确确诊。患者通过抗生素治疗和长期手术引流成功治愈。前2例患者的致病微生物为金黄色葡萄球菌，第3例患者为脆弱拟杆菌。这是首例由这种特定细菌引起的病例报告。我们的患者均无任何易感危险因素。
必须保持高度怀疑指数以便早期识别这种罕见的临床疾病。CT扫描是确诊的标准诊断工具。长期引流和恰当的抗生素对原发性腰大肌脓肿的成功治疗至关重要。
