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• W2170764580 abstract "We wish to call attention to the possibility of iliopsoas abscess after cesarean section to raise awareness of this unusual complication in view of the world-wide concern about high cesarean section rates 1. Our 27-year-old patient was admitted to hospital with weight loss, fever and a 2-month history of right leg pain. She had had a cesarean section with spinal anesthesia 10 months prior to admission. She had no known immunodeficiency. Upon physical examination, the patient was very tired, with a pulse of 110 beats/min, an arterial blood pressure of 110/70 mmHg and a 37.9°C subfebrile temperature. Abdominal and gynecologic examination revealed abdominal tenderness. We observed five or six enlarged inguinal lymphnodes with an approximate maximum diameter of 1–1.5 cm. The patient's serum beta-hCG, hemoglobin, leukocyte and CRP levels were <2, 9.4 g/dL, 11 600, and 8.1, respectively. Ultrasonography revealed a 6 × 5 × 5 cm hypoechoic mass that appeared to be a hematoma or abscess in the medial portion of the right iliopsoas muscle. Computed tomography (CT) confirmed that the mass was an abscess originating in the right iliopsoas muscle. Multiple abscesses were observed in the muscle (Figure 1). Intravenous antibiotic therapy was administered using ceftriaxone and metronidazole. A percutaneous drainage catheter was inserted with ultrasound guidance on the 15th day of antibiotic therapy. The patient was discharged on the 7th day of drainage, in good condition and with reduced abscess size on CT. All signs of the abscess had disappeared at a 6-month follow-up. Iliopsoas abscess is a pus collection in the iliopsoas muscle compartment that spreads throughout the extraperitoneal space. This well-known condition is rare in the general population and more exceptional in obstetric and gynecology patients. A small number of cases have been previously reported in obstetric and gynecology patients, typically following normal delivery, following curettage or during pregnancy 2, 3. To our knowledge, only one case of iliopsoas abscess following cesarean section has been reported 4. In contrast to our patient, this condition is more frequent in men, particularly in patients 44–58 years of age 5. Our patient was only 27 years old, similar to the patient described by Saylam et al. 4. Psoas abscesses can be categorized as primary and secondary abscesses. Primary abscesses occur in immunodeficient people, e.g. patients with diabetes, renal failure, HIV infection. Hematogenous/lymphatic spreading is the main cause. Hematoma secondary to trauma may predispose patients to this condition. Direct spreading of infection creates secondary abscesses, which typically originate from lumbar vertebral inflammation, hip region instrumentation or trauma. Secondary abscesses occur after abdominal surgery, particularly after retroperitoneal area surgery, such as kidney/vertebral operations. Our patient had no predisposing factors except her history of cesarean surgery. Computed tomography and magnetic resonance imaging (MRI) are the best modalities for diagnosis because of the low sensitivity and specificity of ultrasound 5, 6. We observed the mass on ultrasound examination, but because the mass was of unknown origin, we performed a CT scan. Antibiotic therapy and image-guided or open surgical drainage have been reported in the literature 5-7 and we chose both with therapeutic success. Although rare, iliopsoas abscess should be considered in patients who present with fever of unknown origin, weight loss/anorexia, lower abdominal pain, limp or leg pain after cesarean section. In these patients, advanced imaging modalities, such as CT and MRI, should be used. Early diagnosis, management and drainage of the abscess are important to reduce mortality and morbidity. Thus, physicians and gynecologists should be aware of this unexpected complication." @default.
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• W2170764580 date "2014-08-11" @default.
• W2170764580 modified "2023-10-13" @default.
• W2170764580 title "A rare complication of cesarean delivery: iliopsoas abscess" @default.
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• W2170764580 doi "https://doi.org/10.1111/aogs.12452" @default.
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