Psoas abscess rarely requires surgical intervention
Abstract Background Surgeons are increasingly encountering psoas abscesses. Methods We performed a review of 41 adults diagnosed and treated for psoas abscess at a county hospital. Treatment modalities and outcomes were evaluated to develop a contemporary algorithm. Results Eighteen patients had a p...
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| Veröffentlicht in: | The American journal of surgery 2008-08, Vol.196 (2), p.223-227 |
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| creator | Yacoub, Wael N., M.D Sohn, Helen J., M.D Chan, Sirius, M.D Petrosyan, Mikael, M.D Vermaire, Hope M Kelso, Rebecca L., M.D Towfigh, Shirin, M.D Mason, Rodney J., M.D., Ph.D |
| description | Abstract Background Surgeons are increasingly encountering psoas abscesses. Methods We performed a review of 41 adults diagnosed and treated for psoas abscess at a county hospital. Treatment modalities and outcomes were evaluated to develop a contemporary algorithm. Results Eighteen patients had a primary psoas abscess, and 23 had a secondary psoas abscess. Patient characteristics were similar in both groups. Intravenous drug abuse was the leading cause of primary abscesses. Secondary abscesses developed most commonly after abdominal surgery. Treatment was via open drainage (3%), computed tomography–guided percutaneous drainage (63%), or antibiotics alone (34%). Four recurrences occurred in the percutaneous group. Statistical analysis showed that the median size of psoas abscesses in the percutaneous group was significantly larger than in the antibiotics group (6 vs 2 cm; P < .001). The mortality rate was 3%. Conclusions Initial management of psoas abscesses should be nonsurgical (90% success). Small abscesses may be treated with antibiotics alone, and surgery can be reserved for occasional complicated recurrences. |
| doi_str_mv | 10.1016/j.amjsurg.2007.07.032 |
| format | Article |
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Methods We performed a review of 41 adults diagnosed and treated for psoas abscess at a county hospital. Treatment modalities and outcomes were evaluated to develop a contemporary algorithm. Results Eighteen patients had a primary psoas abscess, and 23 had a secondary psoas abscess. Patient characteristics were similar in both groups. Intravenous drug abuse was the leading cause of primary abscesses. Secondary abscesses developed most commonly after abdominal surgery. Treatment was via open drainage (3%), computed tomography–guided percutaneous drainage (63%), or antibiotics alone (34%). Four recurrences occurred in the percutaneous group. Statistical analysis showed that the median size of psoas abscesses in the percutaneous group was significantly larger than in the antibiotics group (6 vs 2 cm; P < .001). The mortality rate was 3%. Conclusions Initial management of psoas abscesses should be nonsurgical (90% success). Small abscesses may be treated with antibiotics alone, and surgery can be reserved for occasional complicated recurrences.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2007.07.032</identifier><identifier>PMID: 18466865</identifier><identifier>CODEN: AJSUAB</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Abdomen ; Adult ; Algorithms ; Anti-Bacterial Agents - therapeutic use ; Biological and medical sciences ; Drainage ; Drug abuse ; Drug therapy ; Female ; General aspects ; Hip joint ; Humans ; Infections ; Male ; Medical imaging ; Medical sciences ; Middle Aged ; Mortality ; Nonsurgical management ; Percutaneous drainage ; Psoas abscess ; Psoas Abscess - diagnostic imaging ; Psoas Abscess - etiology ; Psoas Abscess - therapy ; Radiography, Interventional ; Recurrence ; Risk Factors ; Staphylococcus aureus - isolation & purification ; Substance abuse treatment ; Substance Abuse, Intravenous - complications ; Surgery ; Tomography, X-Ray Computed</subject><ispartof>The American journal of surgery, 2008-08, Vol.196 (2), p.223-227</ispartof><rights>Elsevier Inc.</rights><rights>2008 Elsevier Inc.</rights><rights>2008 INIST-CNRS</rights><rights>Copyright Elsevier Limited Aug 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c476t-ec39c7c49c4520fe98d0f0e910fec25d1f10de38ec92d52d462a99267a89c0db3</citedby><cites>FETCH-LOGICAL-c476t-ec39c7c49c4520fe98d0f0e910fec25d1f10de38ec92d52d462a99267a89c0db3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002961008001815$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20535839$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18466865$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yacoub, Wael N., M.D</creatorcontrib><creatorcontrib>Sohn, Helen J., M.D</creatorcontrib><creatorcontrib>Chan, Sirius, M.D</creatorcontrib><creatorcontrib>Petrosyan, Mikael, M.D</creatorcontrib><creatorcontrib>Vermaire, Hope M</creatorcontrib><creatorcontrib>Kelso, Rebecca L., M.D</creatorcontrib><creatorcontrib>Towfigh, Shirin, M.D</creatorcontrib><creatorcontrib>Mason, Rodney J., M.D., Ph.D</creatorcontrib><title>Psoas abscess rarely requires surgical intervention</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Abstract Background Surgeons are increasingly encountering psoas abscesses. Methods We performed a review of 41 adults diagnosed and treated for psoas abscess at a county hospital. Treatment modalities and outcomes were evaluated to develop a contemporary algorithm. Results Eighteen patients had a primary psoas abscess, and 23 had a secondary psoas abscess. Patient characteristics were similar in both groups. Intravenous drug abuse was the leading cause of primary abscesses. Secondary abscesses developed most commonly after abdominal surgery. Treatment was via open drainage (3%), computed tomography–guided percutaneous drainage (63%), or antibiotics alone (34%). Four recurrences occurred in the percutaneous group. Statistical analysis showed that the median size of psoas abscesses in the percutaneous group was significantly larger than in the antibiotics group (6 vs 2 cm; P < .001). The mortality rate was 3%. Conclusions Initial management of psoas abscesses should be nonsurgical (90% success). Small abscesses may be treated with antibiotics alone, and surgery can be reserved for occasional complicated recurrences.</description><subject>Abdomen</subject><subject>Adult</subject><subject>Algorithms</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Drainage</subject><subject>Drug abuse</subject><subject>Drug therapy</subject><subject>Female</subject><subject>General aspects</subject><subject>Hip joint</subject><subject>Humans</subject><subject>Infections</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nonsurgical management</subject><subject>Percutaneous drainage</subject><subject>Psoas abscess</subject><subject>Psoas Abscess - diagnostic imaging</subject><subject>Psoas Abscess - etiology</subject><subject>Psoas Abscess - therapy</subject><subject>Radiography, Interventional</subject><subject>Recurrence</subject><subject>Risk Factors</subject><subject>Staphylococcus aureus - 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therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Drainage</topic><topic>Drug abuse</topic><topic>Drug therapy</topic><topic>Female</topic><topic>General aspects</topic><topic>Hip joint</topic><topic>Humans</topic><topic>Infections</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Nonsurgical management</topic><topic>Percutaneous drainage</topic><topic>Psoas abscess</topic><topic>Psoas Abscess - diagnostic imaging</topic><topic>Psoas Abscess - etiology</topic><topic>Psoas Abscess - therapy</topic><topic>Radiography, Interventional</topic><topic>Recurrence</topic><topic>Risk Factors</topic><topic>Staphylococcus aureus - isolation & purification</topic><topic>Substance abuse treatment</topic><topic>Substance Abuse, Intravenous - complications</topic><topic>Surgery</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yacoub, Wael N., M.D</creatorcontrib><creatorcontrib>Sohn, Helen J., M.D</creatorcontrib><creatorcontrib>Chan, Sirius, M.D</creatorcontrib><creatorcontrib>Petrosyan, Mikael, M.D</creatorcontrib><creatorcontrib>Vermaire, Hope M</creatorcontrib><creatorcontrib>Kelso, Rebecca L., M.D</creatorcontrib><creatorcontrib>Towfigh, Shirin, M.D</creatorcontrib><creatorcontrib>Mason, Rodney J., M.D., Ph.D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yacoub, Wael N., M.D</au><au>Sohn, Helen J., M.D</au><au>Chan, Sirius, M.D</au><au>Petrosyan, Mikael, M.D</au><au>Vermaire, Hope M</au><au>Kelso, Rebecca L., M.D</au><au>Towfigh, Shirin, M.D</au><au>Mason, Rodney J., M.D., Ph.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Psoas abscess rarely requires surgical intervention</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2008-08-01</date><risdate>2008</risdate><volume>196</volume><issue>2</issue><spage>223</spage><epage>227</epage><pages>223-227</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><coden>AJSUAB</coden><abstract>Abstract Background Surgeons are increasingly encountering psoas abscesses. Methods We performed a review of 41 adults diagnosed and treated for psoas abscess at a county hospital. Treatment modalities and outcomes were evaluated to develop a contemporary algorithm. Results Eighteen patients had a primary psoas abscess, and 23 had a secondary psoas abscess. Patient characteristics were similar in both groups. Intravenous drug abuse was the leading cause of primary abscesses. Secondary abscesses developed most commonly after abdominal surgery. Treatment was via open drainage (3%), computed tomography–guided percutaneous drainage (63%), or antibiotics alone (34%). Four recurrences occurred in the percutaneous group. Statistical analysis showed that the median size of psoas abscesses in the percutaneous group was significantly larger than in the antibiotics group (6 vs 2 cm; P < .001). The mortality rate was 3%. Conclusions Initial management of psoas abscesses should be nonsurgical (90% success). Small abscesses may be treated with antibiotics alone, and surgery can be reserved for occasional complicated recurrences.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>18466865</pmid><doi>10.1016/j.amjsurg.2007.07.032</doi><tpages>5</tpages></addata></record> |
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| subjects | Abdomen Adult Algorithms Anti-Bacterial Agents - therapeutic use Biological and medical sciences Drainage Drug abuse Drug therapy Female General aspects Hip joint Humans Infections Male Medical imaging Medical sciences Middle Aged Mortality Nonsurgical management Percutaneous drainage Psoas abscess Psoas Abscess - diagnostic imaging Psoas Abscess - etiology Psoas Abscess - therapy Radiography, Interventional Recurrence Risk Factors Staphylococcus aureus - isolation & purification Substance abuse treatment Substance Abuse, Intravenous - complications Surgery Tomography, X-Ray Computed |
| title | Psoas abscess rarely requires surgical intervention |
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