Actualización del tratamiento del absceso del psoas apropósito de un caso

Abstract

Psoas muscle abscess is an infrequent but lethal pathology; due to its non-specific clinical manifestations, it is difficult to diagnose; since its first description, its clinical manifestations were given by Mynter's triad (fever, lumbar pain and lameness); however, this only occurs in 30-33% of all cases; the psoas muscle due to its anatomical configuration and its relationship with retroperitoneal and intra-abdominal organs makes it susceptible to infectious processes. A descriptive, analytical and retrospective investigation of an unusual case of unilateral psoas abscess was carried out. We used scientific databases such as Scopus, Springer, Science Direct, Embase, ElSeiver, UpToDate, Cochrane, PubMed; in addition to meta-analysis and scientific articles in high impact journals such as The New England Journal of Medicine, Scielo, BJM Journals published within the last 5 years. We presented the case of a 54-year-old patient with a history of alcoholism, chronic smoker and type 2 diabetes mellitus; who presented 3 months ago with colicky pain in the left lumbar fossa; accompanied by paresthesias in the lower limb, nausea and difficulty in ambulation; abdominal ultrasound identified an irregular lesion of 145x70 mm; a CT scan was performed which showed a collection of 16. 5 cm with a volume of 609 cc and a spondylodiscitis in T12-L1; compatible with inflammatory myopathy due to a left-sided psoas abscess. Psoas abscess is a rare suppurative myositis accompanied by a systemic inflammatory response syndrome due to the involvement of the iliopsoas compartment at the retroperitoneal level; its nonspecific manifestations represent a great diagnostic challenge, requiring a high clinical suspicion and confirmation by tomographic study. Treatment involves the use of antibiotic therapy accompanied by image-guided percutaneous or surgical drainage.