The iliopsoas abscess: aetiology, therapy, and outcome.

BACKGROUND AND AIMS

The treatment strategy for patients with a retroperitonally localised abscess is controversial as it remains open which fluid collections should be drained by open access or by percutaneously inserted drainage.

PATIENTS

Therefore, the data of 40 consecutively treated patients with an iliopsoas abscess were analysed retrospectively.

RESULTS

Ten patients suffered from a primary abscess and ten from a post-operative abscess; further, in 20 patients, the aetiology of the abscesses were due to Crohn's disease, neoplasia, spondylitis or other relevant concomitant diseases. Eight of 40 patients were initially treated by image-guided percutaneous drainage (PD), the other by open access drainage. Six patients died (15%), all of them had been operated; 15 (37.5%) patients had a recurrence of their abscess and needed re-operation. Factors predicting a poor outcome were age, APACHE II score, bi-lateral abscesses and a post-operative or bony cause, but the bacteriological findings did not influence the outcome.

CONCLUSIONS

We suggest an algorithm for treatment of iliopsoas abscesses depending on number and volume of the abscesses.