Abscesses are generally called inflammatory processes with the release of pus. Their nature, for the most part, is contagious. 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 body of dead white blood cells and dead in the battle of bacteria and viruses.
If the pattern of development of the abscess 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 for its diagnosis and treatment will also vary. One of these varieties is psoas abscess. We will analyze its features below.
What it is?
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:
- The large lumbar muscle.
- Small lumbar muscle.
- Iliac muscle
Its direct purpose is as follows: connects the spine and pelvic bones with the femurs. The muscle is also involved in flexion of the spine and legs in the hip joint.
Why psoas abscess? From the Latin name for 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 Classifier of Diseases, this abscess is indicated by code M60.0 - "Infectious myositis." This is a muscle disease (M60-63), soft tissue disease (M60-79), as well as pathology of the connective tissues and musculoskeletal system (M00-M99).
Psoas abscess in ICD-10 is a type of infection of the deep layers of soft tissues. In addition, pyomyositis (acute primary bacterial infection of skeletal muscles) is allocated in the group M60.0. Psoas abscess is called in the classifier an abscess of the psoas major muscle. It is also defined as an infection of the muscle cases.
Differences from pyomyositis
With pyomyositis, the main pathogen is Staphylococcus aureus. But mixed microflora may also be present. As for the abscess of the lumbar muscle, there is no specific pathogen.
There is another important difference between the components of the M60.0 group according to ICD-10. Psoas abscess is by nature a secondary infection. In fact, it will be a consequence of the inflammatory process (or inflamed hematomas) in neighboring tissues. Pyomyositis is the primary inflammatory process that can develop in a damaged muscle.
Abscesses in the retroperitoneal space
There are several types of inflammatory processes:
- Abscess of retroperitoneal anterior space. These are pancreatic and pericardial abscesses. The first is a consequence of destructive pancreatitis or pancreatic necrosis. The second develops with perforation of the duodenum, colon as a result of an ulcer, tumor or wound.
- Abscess of retroperitoneal posterior space. These are abscesses of the perinephric space, which can develop with destructive appendicitis, pyonephrosis, injuries of the perinephric fiber. Subphrenic abscesses are also highlighted. They develop with diffuse peritonitis, perforation of appendicitis, as well as open and closed wounds of the abdominal cavity.
- Psoas abscess. Abscesses in this case can reach large sizes and cause melting of the large lumbar muscle.
Causes of the disease
As medical statistics show, most often such inflammation develops in patients older than 30 years. Its most common cause is Staphylococcus aureus. In some cases, 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 iliac-lumbar muscle. Accordingly, pathogens enter her through the lymphatic and blood vessels.
Sources of infection
Why does a psoas abscess often develop after surgery? To answer the question, imagine the main sources of infection in this case:
- Inflammatory processes developing in the spine. In particular, osteomyelitis, spondylodiscitis.
- The development of inflammation in the surrounding subcutaneous fat.
- 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.
- A severe trauma to the muscle itself, which led to the formation of a hematoma in it, which subsequently became inflamed.
- Conducting medical manipulations on the spine and surrounding soft tissues.
The disease is additionally dangerous in that 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 lumbar muscle attaches to the thigh the lower portion of the spine. That allows her to participate in the flexion of the spine and thigh. If we consider the anatomical atlas, we will see that this muscle will be attached laterally to the spine, to the vertebral bodies and to a number of transverse processes.
Such an arrangement also explains the spread of the inflammatory process. Infections of the spine, which develop in the bodies of the vertebrae or disc spaces, often spread to the adjacent vertebrae. From here, pus can flow out along the lumbar-iliac muscle, involving it in the inflammatory process.
Another way of spreading abdominal infections to the muscle. As for pus, it can flow along the iliopsoas muscle already to 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 lumbar muscle, may also be a consequence 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 internal organs. For example, kidney, pancreas.
Symptoms of the disease
Imagine the main symptoms of psoas abscess:
- Pain in the lower abdomen.
- Discomfort in the groin, as well as the front of the thigh.
- Pain in the lower back.
- When the leg is extended, pain is felt in the area of the hip joint.
- High body temperature, chills, fever.
A person will complain of constant pain in the left or right half of the lower abdomen. Pain 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 passes into the groin area. It feels like muscle tension in the thigh area. As for the groin, the patient will notice an accumulation of some substance.
When walking, pain can also be felt, which gives already to the back. Fever, high fever 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 when the patient is taking non-steroidal anti-inflammatory drugs with which a person is trying to drown out the pain. The patient can be observed for a long time by a neurologist, while the cause of the pain syndrome is not correctly determined.
Diagnostic measures
To find the cause of the pain syndrome in this case, you need to carry out more than one diagnostic procedure. So, 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 his relationship with nearby tissues and internal organs. However, this method has a drawback - an additional radiation load on the subject.
- MRI (magnetic resonance imaging). This method is characterized by all the advantages for which computer tomography is distinguished. The intrinsic advantage of MRI is that using this technique it is possible to determine the initial inflammatory processes in the muscle. That is, the stage that precedes purulent. Another important plus - with this type of diagnosis there is no radiation load on the patient. But the disadvantage of MRI is that with this procedure, the patient must maintain a stationary state for a long time. What is not so easy for people with acute pain. In addition, there are a number of contraindications for MRI.
- Ultrasound (ultrasound 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 infection, the magnitude of the resulting inflammatory process, and also to evaluate how much it affected neighboring organs and tissues.
Surgical treatment
Treatment of psoas abscesses is operational. That is, an operation is performed to surgically open the abscess. Conservative treatment alone is not possible here for the reason that with its help it will not be possible to remove pus, to clean the muscle and tissues and organs adjacent to it from dead cells.
The cavity is washed from purulent matter, after which it is treated with special antiseptic drugs. Special drainages are installed. In the case of a psoas abscess, rehabilitation after surgery will include taking antibiotics prescribed by the doctor.
If to characterize the operation in general, then this is the opening and drainage of the formed abscess. It is opened in two ways: lobotomic or through the abdominal front wall on the right or left side. It depends on the location of the inflammation at the level of the iliac crests. The peritoneum is peeled off to the midline.
Conservative treatment
Drug treatment in this case continues to be 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, then the patient is prescribed medications with the following active substances:
- Ichtammol.
- Cefepime.
- Amikacin.
- Tobramycin.
- Pefloxacin.
- Ampicillin.
- Ciprofloxacin.
- Imipenem.
- Cefpir.
- Lomefloxacin.
- Ticarcillin.
If we talk about forecasts, then here they are generally positive. Provided that a full adequate treatment was prescribed, and an abscess was detected at the initial stage of development, when the inflammation did not spread to other important organs and systems. In this case, the complex 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 large lumbar muscle. He is not treated with drugs - urgent surgical intervention is required, and only then supportive antibiotic therapy.