J Korean Soc Spine Surg.  2016 Dec;23(4):223-226. 10.4184/jkss.2016.23.4.223.

Intractable Psoas Abscess due to Delayed Diagnosis of Tuberculosis of the Colon: A Case Report

• Lee JY
• Jeong SJ
• Kim YS

• KMID: 2365082
• DOI: http://doi.org/10.4184/jkss.2016.23.4.223

Abstract

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.

Keyword

Psoas abscess; Colon tuberculosis

MeSH Terms

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*
Barium

Figure

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  Fig. 1. A psoas abscess was found on abdominal computed tomography.

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  Fig. 2. Barium enema findings suspicious of tuberculosis of the terminal ileum and right ascending colon.

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  Fig. 3. Recurrence of the psoas abscess on abdominal computed tomography.

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  Fig. 4. Magnetic resonance imaging findings of recurred psoas abscess.

Reference

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