Laparoscopic drainage of a recurrent psoas abscess.

Abstract:

BACKGROUND:Many Authors suggest that psoas abscess should initially undergo an antibiotic therapy, with or without percutaneous drainage. In their opinion, surgical drainage should be done in case of failure or complicated recurrences. Herein we report a laparoscopic drainage of a recurrent and multilocular psoas abscess. METHODS:A 43-year-old woman presented to our department with a 4-week history of fever, anorexia, difficulty in walking, and pain in her right flank, lower back and hip. She had a 20-year history of recurrent lower back pain and fever treated with cyclic antibiotic therapy. Abdominal CT scan showed a complex multilocular right psoas abscess and a 17 mm hypodense area in the sixth liver segment. A drainage of the abscess through a laparoscopic access with intraoperative laparoscopic ultrasound of the liver was decided. RESULTS:The patient was discharged on the 3 th postoperative day. Her white blood cell count was normal and she was symptom free. At 1-, 6-, 12- and 24-months-follow-up, neither fever nor lower back pain were reported. CONCLUSIONS:According to our experience, laparoscopic drainage of iliopsoas abscess is safe and effective. However, further studies comparing laparoscopic drainage with open drainage and percutaneous drainage are required in order to define the specific indications of laparoscopic drainage. :Negli ultimi anni, gli ascessi del muscolo ileopsoas sono stati riportati in letteratura con crescente frequenza, probabilmente a causa del largo impiego della TC nella diagnostica differenziale delle algie lombari. Qui presentiamo il caso di una paziente che ha sviluppato un ascesso dell’ileopsoas post-traumatico. Una donna di 43 anni riferiva febbre da 4 settimane, anoressia, dolore al fianco destro e alla regione lombare e difficoltà alla deambulazione. Tale sintomatologia, insorta per la prima volta 20 anni prima in seguito ad una caduta da cavallo, si ripresentava ciclicamente. Per il controllo della febbre e del dolore, la paziente assumeva una terapia antibiotica empirica. Al momento del ricovero gli esami ematochimici mostravano una moderata leucocitosi. La TC dell’addome evidenziava un grosso ascesso multiloculato dello psoas destro ed una lesione ipodensa del sesto segmento epatico. Considerando la lunga storia di infezioni ricorrenti e l’indicazione ad investigare ulteriormente la lesione epatica, si optava per il drenaggio laparoscopico della lesione: aperta completamente la parete dell’ascesso, venivano drenati 550ml di liquido purulento la cui coltura evidenziava la presenza di Stafilococco aureo. Una ecografia del fegato intraoperatoria con sonda laparoscopica escludeva la presenza di una lesione resecabile del sesto segmento epatico e ne confermava la natura infiammatoria. La paziente veniva dimessa in terza giornata operatoria con terapia antibiotica mirata sull’antibiogramma. Nè febbre, nè dolore sono stati più riferiti ai successivi controlli a 1, 6, 12 e 24 mesi dall’intervento. Molti Autori ritengono che gli ascessi dell’ileopsoas possano essere controllati con terapia antibiotica ed eventualmente attraverso il drenaggio percutaneo, riservando il drenaggio chirurgico ai casi complessi o recidivanti. Tuttavia la letteratura non chiarisce se sia da preferire il drenaggio chirurgico con accesso open o laparoscopico. Nella nostra esperienza, il drenaggio laparoscopico è sicuro e consente un drenaggio completo anche degli ascessi multiloculati; inoltre consente la visualizzazione delle strutture anatomiche contigue che potrebbero essere coinvolte dal processo infettivo. Infine l’accesso laparoscopico permette una precoce dimissione e minimi esiti cicatriziali.

journal_name

Ann Ital Chir

authors

Neola B,D'Ambra M,Capasso S,Russo M,Ferulano GP

subject

Has Abstract

pub_date

2014-03-28 00:00:00

issue

ePub

eissn

0003-469X

issn

2239-253X

pii

S2239253X14021847

journal_volume

85

pub_type

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