Psoas (or iliopsoas) abscess is a collection of pus in the iliopsoas muscle compartment . It may arise via contiguous spread from adjacent. Introducción y objetivos. Aportar a la literatura un nuevo caso de absceso primario de Psoas, con afectación también del Cuadrado Lumbar. Absceso del psoas como causa de dolor lumbar detectado mediante gammagrafía con galio en un paciente con sospecha de espondilodiscitisPsoas abscess.
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Psoas muscle abscess after epidural analgesia. Psoas muscle abscess is a rare complication of epidural analgesia.
The adequate approach to this complication is fundamental for a good resolution. The objective of this report was to discuss the diagnosis and treatment of psoas muscle abscess.
A female patient, 65 years old, with neuropathic pain in the lower limbs, difficult to control with systemic drugs. The patient was treated with epidural opioid and local anesthetic as an alternate treatment. Twenty days after the continuous epidural administration, the patient complained of lumbar pain, headache, and fever. A CT scan of the pelvis showed an abscess of the psoas muscle, thus, closed drainage and antibiotics were indicated.
An adequate, continuous supervision of the patient is necessary when an epidural catheter is placed, and it should continue after its removal.
The origin of the psoas muscle is retroperitoneal, at the anterior surface of the transverse process, on the lateral edge of the vertebral bodies from T 12 to L 5. It inserts in psos lesser trochanter of the femur, a short distance below the medial border of its axis.
Along with the upper iliac muscle, the psoas is responsible for the flexion of the thigh; inferiorly, all by itself, it makes the lateral rotation of the vertebral column, and with the iliac muscles it makes the flexion of the trunk. Therefore, its functions include the flexion of the thigh over the hip, and minimal lateral rotation and abduction of the thigh. The psoas muscle has external and clinically important relationships with the kidneys, ureters, cecum, appendix, colon, sigmoid colon, pancreas, lumbar lymph nodes, and nerves of the posterior abdominal wall.
When one of those structures is affected by disease, the use of this muscle can cause pain. Likewise, infections in these organs can, by contiguity, affect the psoas muscle. Psoas abscess is a rare condition 1 and, therefore, not discussed frequently in primary care facilities, but absecso should keep it in mind to make the correct diagnosis.
ABSCESO DE PSOAS
Psoas abscess can be classified as primary or secondary, depending on the presence or absence of a baseline disorder. Eighty-six percent of the patients with primary psoas abscesses were IV drug users 3which is probably due to its rich vascular bed, making it susceptible to the hematogenous spread of infections. The objective of this study was to report the case of a patient with pain in the right lower limb due to peripheral vascular insufficiency.
The patient underwent epidural analgesia for the treatment of pain and developed a secondary psoas abscess.
A white, female patient, 65 years old, was admitted to the hospital with a day history of pain, hyperemia, and bullae in the lower limbs. Past medical history was positive for chronic peripheral vascular disease, valvular cardiopathy, atrial fibrillation, and implantation of a biological mitral valve 11 years before admission. Abwceso included digoxin, pentoxyfillin, and furosemide in the habitual doses.
Physical exam revealed the patient to be anxious, febrile, tachycardic, tachypneic, with edema and hyperemia of the lower limbs. She was diagnosed with cellulites in the lower limbs and treated with intravenous gatifloxacin mg. The infection improved, but the patient continued to complain of severe, continuous pain in the right inferior limb, which increased with ambulation. The patient was referred to the pain clinic, and, due to the suspicion of neuropathic pain secondary to peripheral vascular insufficiency, it was proposed a treatment that consisted of gabapentin, fluoxetine, and a tunneled epidural catheter for the administration of 0.
Twenty days after the procedure, close to the discontinuation of the epidural treatment, the patient presented with lumbar pain, headache, and high fever. Laboratory exams, cultures, and a CT scan of the pelvis were done, and the epidural administration of drugs was discontinued, followed by the removal of the catheter.
[Psoas abscess as a differential diagnosis in emergency department].
A CT scan showed a psoas muscle abscess, and the patient was treated with the closed drainage of abbsceso abscess and ciprofloxacin mg. The patient was discharged after a few days, without complaints, and instructed to follow-up at the outpatient clinic. Several baseline conditions contribute for the formation osoas a secondary psoas muscle abscess. The most important are femoral artery catheterization, genitourinary diseases, gastrointestinal diseases, musculoskeletal disorders, and nerve block with the insertion of a catheter in the lumbar region.
Here we present the case of a psoas muscle abscess secondary to the introduction of an epidural catheter for the treatment of pain difficult to control. Epidural abscess is the main infectious complication of regional anesthetic techniques, and potentially deleteriouswhich, qbsceso uncommon, can be associated with a psoas muscle abscess. Although this suggests the possibility of a coexisting epidural abscess, in the case presented here it was not confirmed by radiological exams.
The absence of epidural infection is possible if the epidural catheter migrates out of the intervertebral foramen and in the presence of contamination of the anesthetic solution 9. Four infectious routes are possible: Based on good hygiene methods and adequate technique during the insertion of the catheter, the fourth possibility is unlikely.
Hematogenous contamination, and contamination of the catheter and anesthetic solution are possible, since there are no established norms for the preparation of those medications in the pharmacy of the hospital where the patient was. The symptoms of psoas abscess are not specific. The patient may present fever, lumbar pain, abdominal pain, and difficulty in walking.
Since the innervation of the psoas muscle is provided by the roots from L 2 to L 4pain secondary to inflammation of this muscle can irradiate anteriorly, to the hips and thighs.
Other symptoms include nausea, malaise, and weight loss.
[Psoas abscess as a differential diagnosis in emergency department].
However, these symptoms are common to several syndromes, hampering the diagnosis In this case, the patient presented lumbar pain, high fever, and headache, which motivated the request for laboratory and radiological exams that demonstrated the presence of a psoas muscle abscess. The treatment of a psoas muscle abscess includes antibiotics and drainage. The most common pathogens guide the choice of antibiotics, which should be adjusted according to the results of culture and sensitivity.
Other pathogens include Serratia marcescens absceeo, Pseudomonas aeruginosaHaemophilus aphrophilusand Proteus mirabilis. Secondary psoas muscle abscess is usually caused by enteric bacteria. Mycobacterium tuberculosis is an extremely absceao cause of psoas muscle abscess in the United States.
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In areas where tuberculosis still is a common disease, it continues to be an important cause In this case, even though cultures were negative, the patient was treated with ciprofloxacin mg.
Psoas muscle abscess is a rare infectious complication of epidural analgesia. The correct diagnosis is fundamental for a good evolution. The patient should be watched closely when an epidural catheter is used, even after its removal. Presentation, microbiology, and treatment.
Br J Anaesth, ; N Abscewo J Med, ; Rev Infect Dis, ; 9: South Med J, ; World J Surg, ; Am J Surg, ; Postgrad Med J, ; Clin Infect Dis, ; All the contents of this journal, except where otherwise absfeso, is licensed under a Creative Commons Attribution License.
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