Iliopsoas abscess

Question 1

What is the most common cause of primary iliopsoas abscess?

Answer 1

Staphylococcus aureus

Question 2

What are common causes of secondary iliopsoas abscess?

Answer 2

• Crohn’s (most common secondary cause)
• Diverticulitis, colorectal cancer
• UTI, GU cancers
• Vertebral osteomyelitis
• Femoral catheter, lithotripsy
• Endocarditis
• IVDU

Question 3

What are the clinical features of iliopsoas abscess?

Answer 3

• Fever
• Back/flank pain
• Limp
• Weight loss

Question 4

Which clinical examinations can be done to help diagnose iliopsoas abscess?

Answer 4

1. Place hand proximal to the patient’s ipsilateral knee and ask patient to lift thigh against your hand. This will cause pain due to contraction of the psoas muscle.
2. Lie the patient on the normal side and hyperextend the affected hip. This should elicit pain as the psoas muscle is stretched.

Question 5

What is the investigation of choice in iliopsoas abscess?

Answer 5

CT abdomen

Question 6

What is the management of iliopsoas abscess?

Answer 6

• Abx

- Percutaneous drainage

Question 7

When is surgery indicated in iliopsoas abscess?

Answer 7

• Failure of percutaneous drainage

- Presence of another intra-abdominal pathology which requires surgery