Santaella R O, Fishman E K, Lipsett P A
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md, USA.
Arch Surg. 1995 Dec;130(12):1309-13. doi: 10.1001/archsurg.1995.01430120063009.
To review the characteristics of patient presentation, microbiology, and treatment of primary iliopsoas abscess.
A case series of patients with iliopsoas abscess diagnosed on computed tomographic scans from 1987 to 1994.
Tertiary care inner-city university hospital.
Eleven patients with secondary iliopsoas abscess, defined as being secondary to gastrointestinal or genitourinary causes or trauma, and seven patients with primary abscess, defined as the absence of the above causes.
Patient characteristics, presenting symptoms and signs, microbiologic characteristics, treatment, and clinical course of patients with primary iliopsoas abscesses compared with those in patients with secondary abscesses.
In the primary group, six patients (86%) were intravenous drug users and four (57%) were positive for human immunodeficiency virus. Staphylococcus aureus grew from cultures from five of seven patients with primary abscesses, whereas secondary abscesses had enteric flora. The typical patient presentation included fever, with complaints of pain in the flank, hip, or abdomen. Comparison of abscess drainage options showed shorter hospitalizations for surgical drainage than for percutaneous drainage (15.9 vs 28.5 days; P < or = .01).
A patient who presents with pain in the flank, hip, or abdomen may have a primary iliopsoas abscess. Computed tomography is the standard method of diagnosis. Antibiotic regimens for patients with primary iliopsoas abscess should include coverage for S aureus, and patients with secondary abscesses should have antibiotic regimens tailored for enteric bacteria. Drainage of abscess is essential for appropriate treatment, and surgical drainage is superior to percutaneous drainage in achieving prompt recovery.
回顾原发性髂腰肌脓肿患者的临床表现、微生物学特征及治疗情况。
对1987年至1994年经计算机断层扫描诊断为髂腰肌脓肿的患者进行病例系列研究。
市中心的三级护理大学医院。
11例继发性髂腰肌脓肿患者，定义为继发于胃肠道或泌尿生殖系统病因或创伤；7例原发性脓肿患者，定义为无上述病因。
原发性髂腰肌脓肿患者与继发性脓肿患者的特征、临床表现和体征、微生物学特征、治疗及临床病程。
在原发性组中，6例（86%）为静脉吸毒者，4例（57%）人类免疫缺陷病毒检测呈阳性。7例原发性脓肿患者中有5例培养出金黄色葡萄球菌，而继发性脓肿患者培养出肠道菌群。典型的患者表现为发热，伴有侧腹、髋部或腹部疼痛。脓肿引流方式的比较显示，手术引流的住院时间比经皮引流短（15.9天对28.5天；P≤0.01）。
出现侧腹、髋部或腹部疼痛的患者可能患有原发性髂腰肌脓肿。计算机断层扫描是标准的诊断方法。原发性髂腰肌脓肿患者的抗生素治疗方案应包括针对金黄色葡萄球菌的覆盖，继发性脓肿患者的抗生素治疗方案应根据肠道细菌进行调整。脓肿引流对适当治疗至关重要，手术引流在实现快速康复方面优于经皮引流。
