Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2015 Mar;22(1):31-35. Korean.
    Published online Mar 31, 2015.
    https://doi.org/10.4184/jkss.2015.22.1.31
    © Copyright 2015 Korean Society of Spine Surgery
    Case Report

    Psoas and Thigh Abscess Caused by Perforated Retrocecal Appendicitis: A Case Report

    Dong-Soo Kim, M.D., Yong-Min Kim, M.D., Eui Sung Choi, M.D., Hyun-Chul Shon, M.D., Suri Chong, M.D., Seung-myung Choi, M.D. and Sang-Jun Park, M.D.
      • Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.
    • Corresponding author: Hyun-chul Shon, M.D. Department of Orthopaedic Surgery, Chungbuk National University Hospital 62, Gaesin-Dong, Cheongju, ChungBuk, 360-711, Korea. TEL: +82-43-269-6077, FAX: +82-43-274-8719, Email: hyunchuls@chungbuk.ac.kr
    Received April 16, 2014; Revised July 14, 2014; Accepted November 28, 2014.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    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.

    Keywords
    Appendicitis; Perforation; Psoas abscess; Thigh abscess; Complication

    Figures

    Fig. 1
    (A) Axial contrast-enhanced CT scan shows multiple septated abscess in the right psoas muscle larger than left sided, and appendicitis, with leakage between the appendix and retroperotoneal fluid collection.(white arrow) (B) Reconstructed coronal contrast-enhanced CT scan shows dissection of the abscesses in the right thigh via the femoral canal, and shows gas containing abscesses in the right thigh.(white arrow) and heterogenous hypodense lesion with enhanced peripheral rim around appendix (asetrisk).

    Fig. 2
    After extensive surgical debridement and hemicolectomy, a percutaneous drainage catheter (arrow) was introduced into the right psoas muscle, and the same procedure (arrow) was performed for the right thigh.

    Fig. 3
    (A) Three-month follow-up axial contrast-enhanced CT scan shows complete resolution (B) Reconstructed coronal contrast-enhanced CT scan also shows resolution. However irregular psoas muscle margine is noted (arrow).

    References

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      1. Haiart DC, Stevenson P, Hartley RC. Leg pain: an uncommon presentation of perforated diverticular disease. J R Coll Surg Edinb 1989;34:17–20.
      1. Haaga RJ, Alfidi RJ, Cooperman AM, et al. Definitive treatment of a large pyogenic liver abscess with CT guidance. Cleve Clin Q 1976;43:85–88.
      1. Kim S, Lim HK, Lee JY, Lee J, Kim MJ, Lee AS. Ascending retrocecal appendicitis: clinical and computed tomographic findings. J Comput Assist Tomogr 2006;30:772–776.
      1. Taiwo B. Psoas abscess: a primer for the internist. South Med J 2001;94:2–5.
      1. An KC, Kim CW, Min YK. Clinical Availability, Diagnosis and Treatment of the Primary Psoas Muscle Abscess. J Korean Soc Spine Surg 2010;17:191–197.
      1. Benoist S, Panis Y, Pannegeon V, et al. Can failure of percutaneous drainage of postoperative abdominal abscesses be predicted? Am J Surg 2002;184:148–153.
      1. Hsieh CH, Wang YC, Yang HR, Chung PK, Jeng LB, Chen RJ. Extensive retroperitoneal and right thigh abscess in a patient with ruptured retrocecal appendicitis: an extremely fulminant form of a common disease. World J Gastroenterol 2006;12:496–499.
    MeSH Terms
    Abscess*
    Appendicitis*
    Drainage
    Fever
    Gastrointestinal Tract
    Humans
    Low Back Pain
    Male
    Pelvis
    Physical Examination
    Psoas Abscess
    Psoas Muscles
    Spasm
    Thigh*
    Metrics
    Share
    Figures
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