Surgery, Universita degli Studi di Milano, Milano, Italy.
IRCCS Policlinico San Donato, San Donato Milanese, Lombardia, Italy.
BMJ Case Rep. 2020 Jul 8;13(7):e235579. doi: 10.1136/bcr-2020-235579.
Psoas abscess is a rare and occasionally life-threatening condition. In the past, the major cause of psoas abscess was a descending infection originating from spine tuberculosis (Pott's disease). Subsequently, secondary infection from spondylodiscitis or Crohn's disease has become the prevalent aetiology. Conventional treatment ranges from antibiotic therapy alone to CT-guided and/or surgical drainage. We present the case of a 67-year-old man with a complex history, including pneumonia, sepsis and previous muscle-skeletal trauma. The patient subsequently developed a psoas abscess that was successfully treated with a minimally invasive retroperitoneoscopic approach and antibiotics. Blood cultures and pus yielded Gram-positive sp, and transesophageal echocardiography identified endocarditis as a possible source of sepsis. Postoperative clinical course was complicated by recurrent sepsis that required a change of antibiotic therapy. The patient was eventually discharged to rehabilitation care without further complications. The retroperitoneoscopic approach is safe and effective for the treatment of cryptogenic psoas abscess.
腰大肌脓肿是一种罕见且偶尔危及生命的病症。过去，腰大肌脓肿的主要病因是源于脊柱结核（波特病）的下行感染。随后，来自脊椎炎或克罗恩病的继发感染成为了常见的病因。常规治疗方法包括单独使用抗生素治疗，以及 CT 引导和/或手术引流。我们报告了一例 67 岁男性的病例，他有复杂的病史，包括肺炎、败血症和先前的肌肉骨骼创伤。随后，该患者发生了腰大肌脓肿，采用微创经腹膜后腹腔镜方法和抗生素治疗获得了成功。血液培养和脓液培养出革兰阳性菌，经食管超声心动图检查发现心内膜炎可能是败血症的源头。术后临床病程复杂，反复发生败血症，需要改变抗生素治疗。最终，患者在没有进一步并发症的情况下出院接受康复治疗。对于隐匿性腰大肌脓肿，经腹膜后腹腔镜方法是安全且有效的治疗方法。
