OBJECTIVE: To investigate the effect of preoperative percutaneous drainage in lumbar tuberculosis with psoas abscess, through compare the clinical efficacy of two different methods. METHODS: Thirty-six patients with lumbar tuberculosis complicated with psoas abscess in corresponding with the inclusion criteria were admitted in Zhejiang Province Traditional Chinese Medicine Hospital from January 2015 to January 2017. The patients were divided into group A and group B according to the different therapeutic methods. All patients were given the standard anti tuberculosis treatment, and percutaneous catheter drainage was used in group A after admission immediately for psoas abscess before operation, while group B with no special treatment. At 3 weeks after anti tuberculosis treatment, 2 patients were excluded in group B, which had to postpone operation because of no reduction in erythrocyte sedimentation rate(ESR) and C reactive protein(CRP). Finally 34 patients were enrolled in this study. There were 18 cases in group A, including 10 males and 8 females, aged from 24 to 73 years old with an average of(42.5±10.2) years. There were 16 cases in group B, including 9 males and 7 females, aged from 23 to 75 years old with an average of(42.3±9.8) years. All patients were treated with posterior pedicle screw fixation, anterior debridement and bone graft fusion. Anterior surgery bleeding volume, operation time, anterior incision length, postoperative anus exhaust time, VAS score, Cobb angle, ESR, CRP changes and postoperative sinus formation were compared between two groups. RESULTS: All patients were followed up for 6 to 21 months with an average of 13 months. At the last follow-up, no mixed infection, tuberculosis recurrence, pedicle screw loosening and nail withdrawal were found. The average operative time, anterior surgery bleeding volume and anterior incision length of group A were less than that of group B(<0.05). Postoperative anal exhaust time of group A was lower than that of group B(<0.05). Improvement degree of ESR, CRP at 3 weeks after anti tuberculosis and 1 week after operation, group A was better than group B(<0.05), and there was no significant difference between two groups in 1 month and 6 months after operation(>0.05). There was 1 case sinus formation in group A and 5 cases in group B, there was significant difference in sinus formation rate between two groups (<0.05). VAS score and Cobb angle at 1 month after operation was obvious improved(<0.05), but there was no significant difference between two groups (>0.05). Spinal cord nerve injury was obvious improved after operation, but there was no significant difference between two groups. CONCLUSIONS Preoperative percutaneous catheter drainage is a safe and feasible method for the treatment of lumbar tuberculosis with psoas abscess. It can increase the effect of anti tuberculosis before operation, reduce the surgical trauma and reduce the incidence of postoperative complications. It can be recommended in clinical application.
Adult ; Aged ; Drainage ; Feasibility Studies ; Female ; Humans ; Lumbar Vertebrae ; Male ; Middle Aged ; Psoas Abscess ; therapy ; Spinal Fusion ; Thoracic Vertebrae ; Treatment Outcome ; Tuberculosis, Spinal ; Young Adult

A 45-year-old woman was admitted due to severe headache and neck stiffness. She had visited a local clinic for back pain and received a lumbar nerve root steroid injection 10 days before admission. Computed tomography and magnetic resonance imaging showed psoas abscess, pneumocephalus, and subdural hygroma. She was diagnosed with psoas abscess and meningitis. The abscess and external ventricle were drained, and antibiotics were administered. Unfortunately, the patient died on hospital day 19 due to diffuse leptomeningitis. Lumbar nerve root steroid injections are commonly used to control back pain. Vigilance to "red flag signs" and a rapid diagnosis can prevent lethal outcomes produced by rare and unexpected complications related to infection. Here, we report a case of fatal meningitis after infection of the cerebrospinal fluid following a lumbar nerve root steroid injection.
Abscess ; Anti-Bacterial Agents ; Back Pain ; Cerebrospinal Fluid* ; Diagnosis ; Female ; Headache ; Humans ; Magnetic Resonance Imaging ; Meningitis ; Middle Aged ; Neck ; Pneumocephalus ; Psoas Abscess ; Subdural Effusion

OBJECTIVETo compare two kinds of method for treating lumbar tuberculosis with psoas abscess, to provide reference for clinical reasonable select of therapy treatment.

METHODSFrom January 2010 to January 2013,42 patients with lumbar tuberculosis combined with psoas abscess with obvious surgical indications were enrolled, including 24 males and 18 females with an average age of (38.5 ± 10.2) years old ranging from 21 to 63 years old. All patients were followed up for 18 to 24 months with an average of 20.9 months. Twenty-two patients underwent posterior vertebral body lesions cleared, bone graft fusion and internal fixation and percutaneous puncture catheter drainage for treatment of psoas major abscess as group A, and twenty patients underwent one-stage extraperitoneal approach to remove abscess, posterior vertebral body lesions cleared, bone graft fusion and internal fixation as group B. The operative time, loss of blood, length of hospital stay, clinical cure rate and other clinical results for the two groups were analyzed and compared.

RESULTSThe loss of blood was (452.3 ± 137.6) ml in group A and (603.5 ± 99.6) ml in group B, there was significant statistical difference (P < 0.05). The time of operation was (193.6 ± 91.2) min in group A and (230.5 ± 56.6) min in group B, there was significant statistical difference (P < 0.05). The time of operation and the loss of blood in group A were obviously less than which in group B. In group A 20 cases were cured and 2 cases relapsed, 19 cases were cured and 1 case relapsed in group B, there was no significant statistical differences between two groups regarding cure rate with chi-square test (χ² = 0.000, P = 1.000). All patients in two groups obtained good clinical curative effect. There were no significant statistical difference between two groups regarding for length of hospital stay with t-test (P > 0.05).

CONCLUSIONLumbar spinal tuberculosis with psoas abscess is not absolute indications for anterior open operation. Compared with the combined anterior and posterior surgical procedure, the percutaneous puncture catheter drainage combined with posterior debridement, interbody fusion and internal fixation can achieve the same clinical effect but less trauma for the patients.

Adult ; Case-Control Studies ; Debridement ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Psoas Abscess ; etiology ; surgery ; Spinal Fusion ; Tuberculosis, Spinal ; complications ; surgery ; Young Adult

An 80-year-old male with nausea and poor oral intake was referred for evaluation of hyponatremia. Primary adrenal insufficiency was diagnosed by a rapid adrenocorticotropic hormone (ACTH) stimulation test. The cause of the adrenal insufficiency was revealed to be adrenal tuberculosis presenting as a bilateral adrenal mass on computed tomography imaging. During the first few months of treatment, the size of the tuberculous mass increased and spread to an adjacent area, and further adrenal hormone replacement was needed. In addition, there was a newly developed tuberculous abscess in a nearby psoas muscle with a duodenal fistula. Thus, we report a case of a long-term clinical course of Addison's disease with changes in hormone replacement as a result of active adrenal tuberculosis, together with a review of the literature.
Abscess* ; Addison Disease* ; Adrenal Glands ; Adrenal Insufficiency ; Adrenocorticotropic Hormone ; Aged, 80 and over ; Fistula* ; Humans ; Hyponatremia ; Male ; Nausea ; Psoas Muscles* ; Tuberculosis*

STUDY DESIGN: Case report. OBJECTIVES: We report a case of meningitis combined with paraspinal infection in a patients who underwent numerous surgeries for and repetitive procedural treatment of the spine. SUMMARY OF LITERATURE REVIEW: In patients with a history surgical and repetitive procedural treatment of the spine, one symptom of infection may be a fever with localized pain or tenderness along the spine. MATERIALS AND METHODS: A 69-year-old man was hospitalized due to pyrexia and myalgia. Eight years ago, he underwented spine surgery. After that, the patient underwent spinal intervention more than once per week in another hospital due to remaining pain. One week before his visit to the emergency room, myalgia and aggravation in the lower back arose. However, a paraspinal infection was not detected in a non-enhanced MRI. One day after admission, the patient showed signs of meningeal irritation signs and the the patient's mental state suddenly deteriorated. An emergency cerebrospinal fluid analysis showed typical findings of bacterial meningitis. An enhanced MRI of the brain showed pachymeningeal enhancement. An enhanced MRI of the spine showed a small abscess formation on the left paravertebral back muscle, and bilateral psoas muscle. RESULTS: Serrtia marcescens was identified on blood cultures obtained upon admission. Since antibiotics were used to treat Serratia marcescens, the fever subsided, and the patient's mental status returned to normal. CONCLUSIONS: For patients with a history of repetitive procedural treatments of the spine, a fever should be acknowledged as a symptom in meningitis or other infectious conditions.
Abscess ; Aged ; Anti-Bacterial Agents ; Back Muscles ; Brain ; Cerebrospinal Fluid ; Emergencies ; Emergency Service, Hospital ; Fever ; Humans ; Magnetic Resonance Imaging ; Meningitis* ; Meningitis, Bacterial ; Myalgia ; Psoas Muscles ; Serratia marcescens ; Spine*

STUDY DESIGN: A case report. OBJECTIVES: To report a rare case of intractable psoas abscess due to delayed diagnosis of colon tuberculosis. SUMMARY OF LITERATURE REVIEW: Most psoas abscesses occur primarily or secondarily due to infection of the vertebral body or discs; however, in rare cases, the etiology is not musculoskeletal in nature. In such cases, since diagnosis and treatment of the causal factor can be delayed, the psoas abscess may recur multiple times and eventually become difficult to treat. MATERIALS AND METHODS: An 18-year-old female patient visited our institution complaining of right lower quadrant abdominal pain and right hip pain. On abdominal computed tomography (CT), a psoas abscess was observed and colon tuberculosis was suspected. She was treated with a ultrasonographically guided percutaneous drainage procedure. Considering the possibility of colon tuberculosis and related fistulae, a barium enema was performed; nonetheless, no fistula was found. After 2 months, the psoas abscess recurred, and thus incision and drainage were performed. Symptoms redeveloped 4 months after the incision and drainage; the patient was further evaluated with magnetic resonance imaging and recurrence of psoas abscess was again observed; incision and drainage were performed once again. A gross draining sinus developed on the right lower abdomen 11 months after the last procedure. On barium enema and abdominal CT scan, an enterocutaneous draining sinus was spotted at the right ascending colon, and right hemicolectomy was thus performed. RESULTS: The psoas abscess did not recur during an 8-year follow-up period after right hemicolectomy. CONCLUSIONS: In treatment of secondary psoas abscess, diagnosis and treatment of the etiology is crucial.
Abdomen ; Abdominal Pain ; Adolescent ; Barium ; Colon* ; Colon, Ascending ; Delayed Diagnosis* ; Diagnosis ; Drainage ; Enema ; Female ; Fistula ; Follow-Up Studies ; Hip ; Humans ; Magnetic Resonance Imaging ; Psoas Abscess* ; Recurrence ; Tomography, X-Ray Computed ; Tuberculosis*

A pressure sore wound is often extensive or complicated by local infection involving adjacent soft tissue and bone. In this case, a regional flap after simple debridement is not adequate. Here, we present a case of an extensive pressure sore in the sacral area with deep tissue infection. A 43-year-old female patient with a complicated sore with deep tissue infection had a presacral abscess, an iliopsoas abscess, and an epidural abscess in the lumbar spine. After a multidisciplinary approach performed in stages, the infection had subsided and removal of the devitalized tissue was possible. The large soft tissue defect with significant depth was reconstructed with a free latissimus dorsi musculocutaneous flap, which was expected to act as a local barrier from vertical infection and provide tensionless skin coverage upon hip flexion. The extensive sacral sore was treated effectively without complication, and the deep tissue infection completely resolved. There was no evidence of donor site morbidity, and wheelchair ambulation was possible by a month after surgery.
Abscess ; Adult ; Debridement ; Epidural Abscess ; Female ; Hip ; Humans ; Myocutaneous Flap ; Osteomyelitis ; Pressure Ulcer* ; Psoas Abscess ; Skin ; Spine ; Superficial Back Muscles ; Tissue Donors ; Walking ; Wheelchairs ; Wounds and Injuries

STUDY DESIGN: Retrospective clinical analysis. PURPOSE: To delineate the clinical presentation of melioidosis in the spine and to create awareness among healthcare professionals, particularly spine surgeons, regarding the diagnosis and treatment of melioidotic spondylitis. OVERVIEW OF LITERATURE: Melioidosis is an emerging disease, particularly in developing countries, associated with a high mortality rate. Its causative pathogen, Burkholderia pseudomallei, has been labeled as a bio-terrorism agent. METHODS: We performed a retrospective analysis of patients who were culture positive for B. pseudomallei. Assessment of patients was performed using clinical, radiological, and blood parameters. Clinical measures included pain, neurological deficit, and return to work. Radiological measures included plain radiography of the spine and magnetic resonance imaging. Blood tests included erythrocyte sedimentation rate and C-reactive protein levels. RESULTS: Four patients having melioidosis with spondylitis were evaluated. All of them had diabetes mellitus; three had multiple abscesses which required incision and drainage. Their clinical spectrum was similar to that of tuberculous spondylitis; all had back pain and radiology revealed infective spondylodiscitis with prevertebral and paravertebral collections with psoas abscess. Three patients underwent ultrasound-guided drainage of the psoas abscess and one had aspiration of the subcutaneous abscess. Bacteriological cultures showed presence of B. pseudomallei, and histopathology showed non-caseating granulomatous inflammation. All patients were treated with intravenous Ceftazidime for 2 weeks, followed by oral bactrim double strength and Doxycycline for 20 weeks. All patients improved with treatment and were healed at follow up. CONCLUSIONS: Melioidosis presents with a clinical spectrum similar to that of tuberculosis. A diagnosis of melioidotic spondylitis should be considered, particularly in patients with diabetes with neutrophilic leukocytosis and clinical-radiological features suggestive of infective spondylodiscitis. Bacteriological culture and histopathology helps in differentiating the two conditions. Health education for healthcare professionals is important for correctly diagnosing this disease.
Abscess ; Anti-Bacterial Agents ; Back Pain ; Blood Sedimentation ; Burkholderia pseudomallei ; C-Reactive Protein ; Ceftazidime ; Delivery of Health Care ; Developing Countries ; Diabetes Mellitus ; Diagnosis ; Discitis ; Doxycycline ; Drainage ; Follow-Up Studies ; Health Education ; Hematologic Tests ; Humans ; Inflammation ; Leukocytosis ; Magnetic Resonance Imaging ; Melioidosis ; Mortality ; Neutrophils ; Psoas Abscess ; Radiography ; Retrospective Studies ; Return to Work ; Spine ; Spondylitis* ; Surgeons ; Trimethoprim, Sulfamethoxazole Drug Combination ; Tuberculosis

Iliopsoas abscess (IPA) is rare in neonates. We present a case of neonatal IPA that was initially believed to bean inguinal hernia. A 20-day-old male infant was referred to our hospital for herniorrhaphy after a 2-day history of swelling and bluish discoloration of the left inguinal area and leg without limitation of motion. Abdominal and pelvic ultrasonography suggested a femoral hernia, but the anatomy was unclear. Abdominal computed tomography revealed a multi-septated cystic mass extending into the psoas muscle from the lower pole of the left kidney to the femur neck. Broad spectrum antibiotics were initiated, and prompt surgical exploration was planned. After opening the retroperitoneal cavity via an inguinal incision, an IPA was diagnosed and surgically drained. Culture of the abscess fluid detected Staphylococcus aureus, sensitive to methicillin. The patient was discharged without complication on the 17th postoperative day.
Diagnosis, Differential ; Drainage ; Hernia, Inguinal/*diagnosis ; Humans ; Infant, Newborn ; Male ; Psoas Abscess/*diagnosis/*therapy ; Radiography, Abdominal/methods ; Rare Diseases ; Republic of Korea ; Staphylococcal Infections/*diagnosis/*therapy ; Tomography, X-Ray Computed/methods ; Treatment Outcome

STUDY DESIGN: A case report. SUMMARY OF LITERATURE REVIEW: The symptoms of psoas abscess are fever, low back pain, and spasm of the psoas muscle. OBJECTIVES: To report a case of psoas and thigh abscess caused by ruptured appendicitis. MATERIALS AND METHODS: A 53- year old male patient visited the complaining of fever, low back pain and thigh pain. Imaging studies revealed psoas abscess and thigh abscess, accompanied by ruptured appendicitis. Therefore, surgical treatment with percutaneous drainage was performed. RESULTS: The patient recovered and returned to his normal life after 2 months. CONCLUSIONS: It is necessary to identify the cause of the infection using physical examination as well as abdominal and pelvis computed tomography when a patient has fever, psoas abscess and thigh abscess. It is also important to be aware that the cause of psoas abscess may also be gastrointestinal tract disease with non specific symptoms.
Abscess* ; Appendicitis* ; Drainage ; Fever ; Gastrointestinal Tract ; Humans ; Low Back Pain ; Male ; Pelvis ; Physical Examination ; Psoas Abscess ; Psoas Muscles ; Spasm ; Thigh*