Abscesses are generally called inflammatory processes with the release of pus. Their nature is, for the most part, infectious. The causative agent of infection enters the thickness of the tissue, the body's defenses react to it with "squads" of leukocytes. As a result of the struggle between these cells and foreign agents, pus is formed. In fact, this mass is the bodies of dead leukocytes and those who died in the battle between bacteria and viruses.
If the pattern of abscess development is similar in many cases, then the locations of the development of this inflammatory process can be very different. Accordingly, complications, causes of inflammation, methods of its diagnosis and treatment will also differ. One of these varieties is the psoas abscess. We will analyze its features further.
What is this?
Psoas abscess is an inflammatory purulent process that occurs in the thickness of the iliopsoas muscle. What is it? This muscle consists of several components:
- Psoas major.
- Psoas minor.
- Iliac muscle.
Its direct purpose is as follows: connectsspine and pelvic bones with femurs. The muscle is also involved in flexion of the spine and legs at the hip joint.
Why is a psoas abscess? From the Latin name of the iliopsoas muscle - m. iliopsoas. Accordingly, for certain reasons, inflammation will develop in it, complicated by purulent discharge.
Psoas abscess in ICD-10
In the International Classification of Diseases, this abscess is designated by the code M60.0 - "Infectious myositis". These are muscle disease (M60-63), soft tissue disease (M60-79), as well as pathologies of connective tissues and the musculoskeletal system (M00-M99).
Psoas abscess in ICD-10 is a type of infection of deep layers of soft tissues. In addition to it, pyomyositis (an acute primary bacterial infection of the skeletal muscles) is distinguished in the M60.0 group. Psoas abscess is named in the classifier as an abscess of the psoas major muscle. It is also defined as an infection of the muscle sheaths.
Differences from pyomyositis
In pyomyositis, the main pathogen is Staphylococcus aureus. But mixed microflora may also be present. As for the psoas abscess, there is no specific causative agent.
There is another important difference between the constituents of the M60.0 group according to ICD-10. A psoas abscess is by its nature a secondary infection. In fact, it will be the result of an inflammatory process (or inflamed hematomas) in neighboring tissues. Pyomyositis is a primary inflammatory process that can develop in a damaged muscle.
Abscesses inretroperitoneum
There are several types of inflammatory processes:
- Abscess of the retroperitoneal anterior space. These are pancreatic and periintestinal abscesses. The first is a consequence of destructive pancreatitis or pancreatic necrosis. The latter develop with perforation of the duodenum, colon as a result of an ulcer, tumor or injury.
- Abscess of the retroperitoneal posterior space. These are abscesses of the perirenal space, which can develop with destructive appendicitis, pyonephrosis, and injuries of the perirenal tissue. There are also subdiaphragmatic abscesses. They develop with diffuse peritonitis, perforation of appendicitis, as well as open and closed wounds of the abdominal cavity.
- Psoas-abscess. Ulcers in this case can reach large sizes and cause melting of the psoas major.
Causes of disease
As shown by medical statistics, most often this inflammation develops in patients older than 30 years. The most common cause is Staphylococcus aureus. In some cases, the pathogens may be Escherichia coli and Pseudomonas aeruginosa, hemolytic streptococci.
These are the main causes of psoas abscess. In this case, the infection spreads from the primary source to the iliopsoas muscle. Accordingly, pathogens enter it through the lymphatic and blood vessels.
Sources of infection
Why does a psoas abscess often develop after surgery? To answer the question, we present the mainsources of infection in this case:
- Inflammatory processes developing in the spine. In particular, osteomyelitis, spondylodiscitis.
- Development of inflammation in the fatty subcutaneous tissue surrounding the muscle.
- Inflammatory processes in the internal organs closest to the muscle - the pancreas, kidneys, appendicular process (therefore, psoas abscess is often a consequence of appendicitis).
- Tuberculosis.
- Severe injury to the muscle itself, which led to the formation of a hematoma in it, which later became inflamed.
- Medical manipulations on the spine and surrounding soft tissues.
The disease is additionally dangerous because the accumulations of pus are not static. They can spread to the surrounding fatty tissue and to the pelvic organs.
Abscess spread
We have already mentioned that the psoas connects the lower part of the spine to the thigh. That allows her to participate in the flexion of the spine and hip. If we look at the anatomical atlas, we will see that this muscle will attach laterally to the spine, to the vertebral bodies and a number of transverse processes.
This location explains how the inflammatory process spreads. Spinal infections that develop in the vertebral bodies or disc spaces often spread to adjacent vertebrae. From here, pus can flow along the lumboiliac muscle, involving it in the inflammatory process.
Another way to spread tomuscle infection from the abdomen. As for the pus, it can flow down the iliopsoas muscle already towards the groin.
It should be noted that psoas abscess can be a secondary disease that develops after Crohn's disease, colorectal cancer or diverticulosis. Also, the paraspinal process, affecting the psoas muscle, may be the result of osteomyelitis.
As we have already noted, tuberculosis can also be called one of the common causes of psoas abscess. In some cases, inflammation of the iliopsoas muscle will be the result of a rupture, opening of an abscess of the internal organs. For example, kidney, pancreas.
Symptoms of disease
Let's imagine the main symptoms of psoas abscess:
- Pain in the lower abdomen.
- Feeling of discomfort in the groin area, as well as the front of the thigh.
- Pain in the lower back.
- Pain is felt in the area of the hip joint when the leg is extended.
- High body temperature, chills, fever.
The person will complain of constant pain in the left or right half of the lower abdomen. Pain syndrome can be felt in them at the same time. Often there is discomfort in the front of the thigh. With a certain spread of infection, it also passes into the groin area. It feels like a muscle tension in the thigh area. As for the groin, the patient will notice as if the accumulation of some substance.
When walking, pain can also be felt, which already radiates to the back. Fever, hightemperature are common signs of an active inflammatory process in the body.
The condition is dangerous because the clinical picture in most cases is erased. Especially against the background of the patient taking non-steroidal anti-inflammatory drugs, with which a person is trying to drown out the pain. The patient can be observed by a neurologist for a long time, while the cause of the pain syndrome is incorrectly determined.
Diagnostic measures
To find the cause of the pain syndrome in this case, you need to carry out more than one diagnostic procedure. Thus, the diagnosis of psoas abscess should include the following:
- MSCT (computed tomography). This procedure helps to judge the prevalence of the inflammatory process. And also about its relationship with nearby tissues and internal organs. However, this method also has a drawback - additional radiation exposure to the subject.
- MRI (magnetic resonance imaging). This method is characterized by all the advantages for which computed tomography is distinguished. The advantage of MRI is that with the help of this technique it is possible to determine the initial inflammatory processes in the muscle. That is, the stage that precedes the purulent. Another important plus is that with this type of diagnosis there is no radiation exposure to the patient. But the disadvantage of MRI is that during this procedure, the patient must remain motionless for a long time. What is not so easy for people with acute pain syndrome. In addition, for an MRIthere are a number of contraindications.
- Ultrasound (ultrasound examination of the abdominal cavity). Using this procedure, it is also possible to identify purulent-inflammatory processes affecting the iliopsoas muscle, as well as their volume. But compared to the above, this is a less accurate method. Nevertheless, a sound examination almost always allows you to find the source of the spread of the infection, the magnitude of the resulting inflammatory process, and also assess how it affected neighboring organs and tissues.
Surgical treatment
Surgical treatment of psoas abscesses. That is, an operation is performed to surgically open the abscess. Only conservative treatment is impossible here for the reason that with its help it will not be possible to remove pus, clean the muscle and adjacent tissues and organs from dead cells.
The cavity is washed from purulent matter, after which it is treated with special antiseptic preparations. Installed special drains. In the case of a psoas abscess, rehabilitation after surgery will include taking antibiotics prescribed by a doctor.
If you characterize the operation in general, then this is the opening and drainage of the formed abscess. It is opened in two ways: lobotomically or through the abdominal anterior wall on the right or left side. It depends on the localization of inflammation at the level of the iliac crests. The peritoneum is peeled off to the midline.
Conservative treatment
Drug treatment in this casecontinues surgical. This is a special antibacterial therapy, selected taking into account the type of pathogen that caused the inflammatory process.
As for the modern medical treatment of psoas abscesses, the patient is prescribed drugs with the following active substances:
- Ihtammol.
- Cefepim.
- Amicacin.
- Tobramycin.
- Pefloxacin.
- Ampicillin.
- Ciprofloxacin.
- Imipenem.
- Cefpirom.
- Lomefloxacin.
- Ticarcillin.
If we talk about forecasts, then they are generally positive. Provided that a full-fledged adequate treatment was prescribed, and the abscess was detected at the initial stage of development, when the inflammation did not spread to other important organs and systems. In this case, a combination of surgical and conservative therapy leads to a complete recovery of the patient.
Psoas abscess is a rather serious condition in which an inflammatory purulent process develops in the psoas major muscle. It is not treated with drugs - urgent surgery is required, and only then maintenance antibiotic therapy.
