Guerrero Veronica, Park Agnes, Zhou Steven Y
General Surgery, Northwestern Medicine McHenry Hospital, McHenry, USA.
General Surgery, Chicago Medical School, North Chicago, USA.
Cureus. 2023 Feb 7;15(2):e34749. doi: 10.7759/cureus.34749. eCollection 2023 Feb.
Iliopsoas abscesses (IPAs) are rare infections in the musculature that can be difficult to diagnose due to nonspecific presentations. These abscesses are most commonly caused by either the hematogenous spread of a separate infectious source in the body or secondary to Crohn's disease and are typically treated with antibiotic therapy and percutaneous drainage. For cases complicated by bowel disease, multiloculated psoas abscess, or gas-forming organisms, surgical drainage may be indicated. We present the case of an 81-year-old female with a history of colon cancer status post-cecum resection who presented with back pain, thigh pain, and constipation. Computerized tomography imaging showed concurrent small bowel obstruction and a right IPA extending down to the right thigh. Laparoscopic exploration revealed a small bowel fistulization to the right iliopsoas as the source of infection. Resection of the small bowel and surgical incision and drainage of the abscess were necessary for her treatment. The patient was discharged with vacuum-assisted closure of her wound after a hospital course complicated with chronic diarrhea. Bowel fistulization should be considered a potential cause of IPAs in patients with a complicated gastrointestinal history.
髂腰肌脓肿（IPA）是肌肉组织中罕见的感染，由于临床表现不具特异性，可能难以诊断。这些脓肿最常见的病因是身体内其他感染源的血行播散或继发于克罗恩病，通常采用抗生素治疗和经皮引流。对于合并肠道疾病、多房性腰大肌脓肿或产气菌感染的病例，可能需要手术引流。我们报告一例81岁女性患者，有盲肠切除术后结肠癌病史，出现背痛、大腿疼痛和便秘。计算机断层扫描成像显示同时存在小肠梗阻和一个延伸至右大腿的右侧IPA。腹腔镜探查发现小肠与右髂腰肌形成瘘管，为感染源。为治疗该患者，需要切除小肠并对脓肿进行手术切开引流。患者在经历了伴有慢性腹泻的住院过程后，伤口采用负压封闭引流出院。对于有复杂胃肠道病史的患者，应考虑肠瘘是IPA的潜在病因。
